Implementation Strategies and Ergonomic Factors in Robot-assisted Microsurgery

Robot-assisted surgery represents a significant innovation in reconstructive microsurgery, providing enhanced precision and reduced surgeon fatigue. This study examines the integration of robotic assistance in a series of 85 consecutive robot-assisted microsurgical (RAMS) operations. It aims to evaluate changes in the integration of RAMS during the implementation phase in a single institution. The study utilized a prospective database encompassing all robot-assisted microsurgical cases using the Symani surgical system from February until December 2023. A total of 85 robot-assisted operations were analyzed, showing a broad application across various types of reconstructive needs, predominantly in lower extremity repairs (n = 41). There were 68 free flap reconstructions (80.0%), ten nerve transfers (11.8%), four targeted muscle reinnervations (TMR; 4.7%), two lymphovenous anastomoses (2.4%) and one arterial reconstruction. The adoption of both traditional and digital exoscopic magnification systems was optimized for each surgical context. The operating room setup and infrastructural challenges for the different anatomic regions are presented. The introduction of robot-assisted surgery entailed overcoming challenges such as adapting to the lack of haptic feedback and navigating ergonomic constraints. Despite these hurdles, including higher operational costs and increased surgery durations, the precision and ergonomic benefits offered by robotic systems may be substantial. Potential solutions and tips to improve the operating times include frequent cleaning of the instruments, active surgical assistance, and rigorous presurgical planning of the logistical setup in the operating room. We showed that there is a preference for the utilization of digital exoscopes over conventional microscopes in RAMS, despite requiring more time per stitch when using the exoscope.