Real-time digital assistance improves surgeon efficiency and autonomy in robotic microvascular anastomosis: a pilot feasibility study

Robotic microsurgery offers greater precision compared to manual surgical techniques and enables vascular anastomoses at submillimeter scales. This pilot study evaluated the incorporation of the Synaptix® Digital Surgery Platform, which provides a real-time system information overlay displaying essential data such as instrument status, motion scaling, and recovery details, with the Symani® Surgical System for microvascular anastomosis. Three surgeons (plastic surgery, neurosurgery, and head and neck) performed 1–2 mm synthetic vessel anastomoses using Symani alone and Symani with Synaptix. Metrics included Anastomosis Time, Teleoperation Exits, Re-Entry Time, Re-Entry Attempts, Assistant Use, and Exit Reason Match (alignment between system-logged and surgeon-identified explanations for each teleoperation exit event). Compared with Symani alone, mean Anastomosis Time was numerically shorter with Symani + Synaptix (20% reduction; 24.2 ± 7.2 vs. 19.4 ± 5.2 min), though this difference did not reach statistical significance (n = 3). Teleoperation Exits decreased by 44% (4.5 ± 0.5 vs. 2.5 ± 0.71). Re-Entry Time was reduced by 50% (0.38 ± 0.13 vs. 0.19 ± 0.01 min), and Re-Entry Attempts decreased by approximately 10%. Assistant Use decreased from 15% to 0%. Exit Reason Match was 75% when Synaptix was used with Symani compared to 26% when Symani was used without Synaptix. All surgeons reported that Synaptix improved visualization, reduced fatigue, and increased autonomy. Although performance gains varied by surgeon and vessel size, each demonstrated measurable benefit. These findings indicate that real-time digital assistance may streamline workflow, enhance performance across expertise levels, and facilitate broader adoption of robotic open microsurgery.