Robotic-Assisted Microsurgery in Gender-Affirming Phalloplasty

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.
• 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.