Robotic assisted free flap reconstruction of the scalp using the Symani^® surgical system

Robotic-assisted surgery currently is evolving as a new field in microsurgery with potential benefits for reconstructive surgery. The Symani^® Surgical System has shown feasibility in performing microsurgical anastomosis. Reconstruction of the soft tissue of the scalp is commonly necessary after brain surgery with reconstruction of the cranium using foreign materials such as PEEK (Polyether ether ketone). We describe our experience with free soft tissue transfer with a free anterolateral thigh (ALT) flap or free latissimus dorsi (LD) flap for reconstruction of the scalp using the Symani^® Surgical System for microsurgical anastomosis.

We analyzed 6 patients with soft tissue defects of the scalp from September 2023 to January 2024 undergoing soft tissue reconstruction with a free ALT or LD flap. Robotic-assisted microsurgical anastomoses were performed using the Symani^® Surgical System.

4 male patients and 2 female patients (age 61-81 years, mean 71.8 years) were included. Mean hospital stay was 10 (8-13) days. The most common recipient vessels were the Superficial temporal artery and vein (66.7%). In other cases, we used the facial artery and vein. All arterial anastomoses were performed by using the Symani^® Surgical System. The mean operative time was 387 (328-48) minutes. The mean anastomosis time using the Symani^® Surgical System was 32.5 (19-44) minutes. No flap loss was observed. One patient suffered from a PEEK infection as a delayed post-operative complication.

For reconstruction of soft tissue defects of the scalp, a free ALT or LD flap represents a proper treatment option. Performing microanastomosis using the Symani^® Surgical System is a safe technology and is leading to satisfactory outcomes.