Initial feasibility assessment of robotic-assisted cleft lip repair in an in-vitro model

Cleft lip remains technically demanding, often requiring revisions for scar widening, notching, short lip, and asymmetry. Millimeter-level precision in tissue handling and suturing is critical, paralleling microsurgery, where robotic platforms have conferred benefits through tremor filtration and enhanced visualization. This study evaluated the technical feasibility of robotic-assisted cleft lip repair using an in vitro 3D model, focusing on three primary steps: orbicularis oris dissection and approximation, and dermal approximation. Using the Symani Surgical System, three robotic trials were performed using a modified Fisher technique. Manual in vitro and in vivo repairs served as controls. Completion times, stoppages, sutures placed, and complications were recorded. Robotic orbicularis oris dissection was feasible and improved with experience, decreasing from 14 to 6 min. Dermal approximation was also feasible, with suturing times decreasing from 34 to 19 min, and satisfactory tissue opposition was achieved. In contrast, robotic muscle approximation was infeasible due to insufficient force generation, prolonged completion times, and limited successful suture placement. In summary, the robotic platform provided enhanced optics, tremor elimination, and ergonomic positioning. Robotic-assisted cleft lip repair is feasible for select steps but not yet suitable for full repair, supporting needs in model refinement, task-specific training, and future higher-powered, outcome-based studies.