Ideal suturing technique for robot-assisted microsurgical anastomoses.

Area of Science:

• Robotics in Surgery
• Microsurgery Techniques
• Vascular Anastomosis

Background:

• Robotic devices enhance precision in open microsurgery but often increase surgical time.
• Novel robotic systems aim to improve efficiency and ergonomics in reconstructive procedures.
• Comparing suturing techniques is crucial for optimizing robot-assisted microsurgery.

Purpose of the Study:

• To compare the efficacy of two robotic suturing techniques: "steady-thread" and "switch-thread".
• To evaluate the impact of these techniques on anastomosis time, surgeon satisfaction, and skill.
• To quantify technical errors and thread ruptures associated with each technique.

Main Methods:

• Six experienced microsurgeons performed microvascular anastomoses on 1.0-mm artificial vessels.
• Utilized the Symani Surgical System and RoboticScope for "steady-thread" and "switch-thread" techniques.
• Assessed anastomosis time, surgeon satisfaction, anastomosis quality (Anastomosis Lapse Index), and microsurgical skills (Structured Assessment of Microsurgery Skills).

Main Results:

• The "steady-thread" technique was significantly faster for knot tying (4.11 min vs. 6.40 min) and rated higher by participants.
• Microsurgical skills were significantly better with the "steady-thread" technique.
• Both techniques yielded high anastomosis quality, with slightly fewer errors for "steady-thread" (2.61 vs. 3.0 errors).
• The "switch-thread" technique resulted in more technical errors and double the thread ruptures.

Conclusions:

• The "steady-thread" suturing technique demonstrates enhanced performance in robot-assisted microsurgery.
• This technique improves efficiency through faster knot tying and better surgeon-rated skills.
• The "steady-thread" technique is recommended for robot-assisted microsurgical procedures to optimize outcomes.