Early institutional adoption of robotic-assisted microsurgical reconstruction: A retrospective descriptive study

Robotic microsurgery enables submillimetric precision and enhanced dexterity. However, early real-world clinical experience remains limited. This study describes early institutional adoption of robotic-assisted microsurgery across free flap and lymphatic reconstructive procedures, with a focus on utilization patterns and operative performance.

A single-center retrospective review was performed from September 2024 to September 2025. Patients who underwent free flap breast reconstruction, immediate lymphatic reconstruction (ILR), or lymphaticovenous bypass (LVB) were included. Robotic cases were performed using the Symani Surgical System for microvascular anastomosis, whereas manual cases were performed using conventional techniques. Demographics, operative characteristics, and postoperative outcomes were summarized descriptively.

A total of 118 procedures were analyzed (36 robotic and 82 manual). Robotic use was most common in ILR (52.8%), followed by free flap breast reconstruction (33.3%) and LVB (13.9%), with variation across surgeons. Mean operative duration was longer in robotic cases for free flap (594.7 ± 109.6 vs. 532.1 ± 139.6 min) and ILR procedures (92.4 ± 23.6 vs. 49.4 ± 18.1 min), consistent with early-phase adoption. Postoperative complications and anastomotic revision occurred in robotic and manual groups without a consistent pattern favoring either approach. Anastomosis time varied across sequential cases, with a general reduction observed over time.

This study describes early institutional experience with robotic-assisted microsurgery, demonstrating technical feasibility and variability in its utilization during initial adoption. Findings suggest improving operative efficiency with experience. Further prospective studies are needed to better define long-term outcomes and comparative effectiveness.