Robotic-Assisted Lymphovenous Anastomosis: A Systematic Review of Surgical Outcomes

Lymphovenous anastomosis (LVA) is an established microsurgical treatment for lymphedema. Robotic assistance in LVA procedures (RoboLVA) has emerged as a promising advancement, yet its effectiveness and clinical outcomes have yet to be systematically evaluated.

A systematic review following PRISMA guidelines was conducted using PubMed and manual searching for studies published between January 2000 and December 2024. Included studies reported outcomes of robotic-assisted LVA procedures. Risk of bias was assessed using appropriate tools including RoB 2 and ROBINS-I.

Thirteen studies comprising 257 patients who underwent 225 robotic-assisted lymphovenous anastomoses were included. Mean anastomosis duration ranged from 16 to 25.3 min. Initial patency rates were 97%-100%, with a 12-month patency of 66.6% for RoboLVA versus 81.8% for manual LVA. Volume reduction was achieved in 86% of upper extremity cases (mean: -7.6%) and 72% of lower extremity cases (mean: -1.4%). Complications were minimal, primarily including vessels anastomotic thrombosis and wound infections. Surgeon satisfaction scores were lower for RoboLVA (3.1 ± 0.6) compared to manual LVA (3.8 ± 0.8), though ergonomic benefits were noted.

RoboLVA demonstrates comparable technical success and clinical outcomes to manual techniques, with high initial patency rates and a significant number of patients who experienced volume reductions in treated limbs. While operative times are longer, a clear learning curve effect suggests improved efficiency with experience. The technology shows promise for lymphedema treatment, though larger randomized trials with longer follow-up are needed to establish long-term comparative efficacy.