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Robotic-Assisted Microsurgery in Gender-Affirming Phalloplasty.

Sascha Wellenbrock, Mahmut Ozturk, Michael Sohn1

  • 1Department of Urology, AGAPLESION Markus Hospital, Frankfurt am Main.

Annals of Plastic Surgery
|December 12, 2024
PubMed
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Robotic microsurgery using the Symani Surgical System and RoboticScope facilitated gender-affirming phalloplasty, enabling precise nerve and vessel anastomosis in deep surgical planes.

Area of Science:

  • Microsurgery
  • Robotic Surgery
  • Gender-Affirming Surgery

Background:

  • Genital gender-affirming surgeries demand intricate dissection of small vessels and nerves in deep surgical planes.
  • The Symani Surgical System offers enhanced dexterity for microsurgery through tremor elimination, motion scaling, and additional distal motion axes.
  • Combining robotic systems can optimize surgeon ergonomics and procedural flexibility.

Purpose of the Study:

  • To present the initial application of robotic-assisted microsurgery for gender-affirming phalloplasty.
  • To evaluate the feasibility of using the Symani Surgical System with a robotic exoscope in this procedure.

Main Methods:

  • The Symani Surgical System and RoboticScope were utilized for robotic-assisted microsurgery during phalloplasty.

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  • Key procedures included end-to-side nerve coaptation and end-to-end arterial and venous anastomoses.
  • Suturing involved 9.0 and 8.0 Ethilon sutures for nerve and artery, respectively, with a coupler for vein anastomosis.

    • Main Results:

    • Nerve coaptation was completed in 17 minutes, arterial anastomosis in 26 minutes, and venous anastomosis in 6 minutes.
    • Total flap ischemia time was 157 minutes, with an overall procedure time of 401 minutes.
    • The robotic system facilitated precise anastomoses and allowed flexible manipulation in deep surgical areas.

    Conclusions:

    • Robotic-assisted microsurgery with the Symani system and RoboticScope is feasible for gender-affirming phalloplasty.
    • The technology demonstrated potential for precise vessel and nerve handling in deep surgical planes.
    • Further research is warranted to explore the full benefits of this robotic approach in gender-affirming procedures.