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Implementation Strategies and Ergonomic Factors in Robot-assisted Microsurgery
F Struebing1, E Gazyakan1, A K Bigdeli1
1BG Trauma Center Ludwigshafen, Department for Plastic, Hand and Reconstructive Surgery, Department of Plastic Surgery for the Heidelberg University, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
Journal of Robotic Surgery
|January 3, 2025
Summary
Robot-assisted microsurgery (RAMS) enhances precision in reconstructive surgery. This study of 85 RAMS operations shows broad application, particularly in lower extremity repairs, despite challenges like longer surgery times.
Area of Science:
- Microsurgery
- Surgical Robotics
- Reconstructive Surgery
Background:
- Robot-assisted surgery (RAS) offers enhanced precision and reduced surgeon fatigue in reconstructive microsurgery.
- Implementation of RAS requires evaluating integration and overcoming specific challenges.
Purpose of the Study:
- To evaluate the integration and application of robot-assisted microsurgery (RAMS) during its implementation phase.
- To analyze the types of reconstructive procedures performed using RAMS.
- To identify challenges and solutions associated with RAMS adoption.
Main Methods:
- Prospective analysis of 85 consecutive robot-assisted microsurgical cases using the Symani surgical system (February-December 2023).
- Evaluation of procedure types, including free flap reconstructions, nerve transfers, and others.
- Assessment of operating room setup, magnification systems (digital exoscopes vs. microscopes), and infrastructural challenges.
Main Results:
- RAMS demonstrated broad applicability, predominantly in lower extremity repairs (41 cases).
- Free flap reconstructions constituted the majority of procedures (80.0%).
- A preference for digital exoscopes over conventional microscopes was observed, despite increased time per stitch.
Conclusions:
- Robot-assisted microsurgery is feasible for various reconstructive needs, with a notable application in lower extremity repairs.
- Challenges such as lack of haptic feedback, ergonomic constraints, and increased operative time were identified.
- Strategies like instrument cleaning, active assistance, and presurgical planning can optimize RAMS, and digital exoscopes are preferred for visualization.
