In vivo microsurgical training with the symani^® robot: early experience and feasibility

Robotic microsurgery offers important advantages in vascular anastomoses and nerve sutures, particularly for structures < 1 mm as required in supermicrosurgery. The Symani^® surgical robot provides micrometric movements and tremor elimination through motion scaling, improving precision and reducing operator fatigue. Although several studies have investigated Symani-related training and learning curves, most were conducted on synthetic or in vitro animal models. The few studies performed on in vivo rat models involve microvascular surgeons with many years of experience in traditional microsurgery, rather than residents with no experience in robotic microsurgery and only limited exposure to conventional microsurgery. During the Advanced Microsurgery Course 2025 in Naples (Italy), held between May and December 2025, 14 participants with no prior robotic microsurgery experience and minimal conventional microsurgical training performed first a practice session on a silicone synthetic model to become familiar with the robot, and subsequently on in vivo murine models using the Symani^® robot. Data from the in vivo exercise were collected and compared, focusing on time required to complete individual knots and intraoperative complications. Participants demonstrated rapid acquisition of operative skills, showing a reduction in suturing time during in vivo procedures, which indicates a fast adaptation to the robotic platform even among inexperienced operators. The Symani^® robotic microsurgery system is intuitive and associated with a steep learning curve, even for users with no prior exposure to robotic microsurgery and only basic training in traditional microsurgery. This supports its potential as an effective training platform and clinical tool in supermicrosurgery.