The Current Landscape of Robotics in Lymphatic Supermicrosurgery: A Systematic Review.

Area of Science:

• Laparoscopic and robotic surgery
• Microsurgery
• Vascular surgery

Background:

• Lymphedema impacts over 250 million globally, with supermicrosurgical procedures like lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT) becoming standard. These techniques demand specialized training and can be challenging in confined anatomical spaces.
• Robotic surgical systems offer potential benefits for lymphatic supermicrosurgery, including enhanced visualization, motion scaling, tremor reduction, and improved ergonomics.
• Current evidence on the safety, feasibility, and clinical outcomes of robotic-assisted lymphatic supermicrosurgery is limited.

Purpose of the Study:

• To systematically review the existing literature on robotic-assisted peripheral lymphatic reconstruction.
• To evaluate the safety, feasibility, and outcomes of robotic techniques compared to conventional manual methods in lymphatic supermicrosurgery.

Main Methods:

• A systematic review was conducted following PRISMA guidelines, searching PubMed, Cochrane Library, and Embase.
• Included studies focused on human clinical reports of robotic-assisted peripheral lymphatic reconstruction.
• Data extracted included patient demographics, operative details, clinical outcomes, and study quality.

Main Results:

• Seven studies involving 134 patients and 221 anastomoses were analyzed, with 78% performed robotically, primarily using the Symani system.
• Robotic procedures predominantly included LVBs (59.9%) and VLNTs (32%).
• While initial robotic procedures had longer anastomotic times (25.7 min vs. 11 min manually), experience led to significant time reduction. Clinical outcomes and quality-of-life measures were comparable between robotic and manual groups, with advantages in tremor elimination and ergonomics, despite challenges like cost and lack of haptic feedback.

Conclusions:

• Robotic-assisted lymphatic supermicrosurgery demonstrates safety and feasibility, yielding outcomes comparable to traditional manual techniques.
• Further advancements in robotic technology, cost-effectiveness, and standardized outcome reporting are crucial for its broader adoption in lymphatic reconstruction.
• Robotic systems hold promise for expanding therapeutic and preventive options in managing lymphedema.