Robot-Assisted Lymph Node-to-Vein Anastomosis: Lessons from the First 22 Cases at a High-Volume Lymphatic...

Area of Science:

• Microsurgery
• Robotic Surgery
• Vascular Surgery

Background:

• Lymphedema is a frequent complication of cancer treatment.
• Supermicrosurgical techniques like lymphaticovenular anastomosis (LVA) and lymph node-to-vein anastomosis (LNVA) are effective for fluid-predominant lymphedema.
• Robotic assistance is a novel advancement in supermicrosurgery.

Purpose of the Study:

• To describe the initial experience with robot-assisted LNVA.
• To share technical insights and evaluate the feasibility of robotic supermicrosurgery.
• To explore the potential of robotics in extending surgical precision for lymphatic and intracranial diseases.

Main Methods:

• Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon.
• Preoperative imaging (standard and ultra-high frequency ultrasound) guided lymph node and vein selection.
• The Symani Surgical System was utilized, with specific adaptations for enhanced motion scaling, ergonomics, and console control. Intraoperative patency was confirmed using direct washout and/or indocyanine green (ICG) transit.

Main Results:

• All 22 robotic LNVA procedures were technically successful, achieving 100% intraoperative patency.
• The average anastomosis time decreased significantly from 37 minutes to 18 minutes.
• Robotic assistance demonstrated improved precision, tremor elimination, and reduced technical difficulty at submillimeter scales.

Conclusions:

• Robot-assisted LNVA is a safe, feasible, and efficient procedure for lymphedema treatment.
• This robotic approach optimizes existing supermicrosurgical techniques.
• Robotic assistance has the potential to enable surgery at scales below 0.1 mm, expanding possibilities for lymphatic and intracranial conditions.