Dedicated Robotic-Assisted Microsurgery Platforms in Plastic and Reconstructive Surgery: A Systematic Review

Dedicated robotic-assisted microsurgical systems (RAMS), including the Symani Surgical System and MUSA, were developed to overcome physiological tremor, surgeon fatigue, and restricted maneuverability in deep surgical fields. Existing reviews of robotic plastic surgery largely span heterogeneous applications beyond microsurgery or lack structured risk-of-bias appraisal specific to dedicated microsurgical platforms. This review systematically synthesizes clinical outcomes, learning-curve dynamics, and technological features of dedicated RAMS platforms in microsurgery, incorporating structured risk-of-bias appraisal to clarify the evidence base and inform clinical adoption.

Studies published 2015-2025 were identified through PubMed, Embase, Scopus, and Web of Science (PROSPERO CRD420261320086). Following independent screening, 21 studies were included, assessing free flap survival, anastomotic patency, complications, operative times, and learning-curve metrics.

Free flap reconstruction showed high survival (96%-100%); supermicrosurgical anastomosis patency was 96.6%-100%. Robotic anastomosis times fell 51%-66% with experience (largest reduction 66.1%, for deep-plane arterial anastomosis), though times remained longer than manual benchmarks even after the learning phase (e.g., 25.3 ± 12.3 vs. 14.1 ± 4.3 min for mixed procedures). Conversion/failure was infrequent (0%-4.3%). Motion scaling (up to 20×) and tremor filtration were consistent advantages; haptic feedback remained universally absent.

Dedicated RAMS platforms are safe and effective for micro- and supermicrosurgical reconstruction, non-inferior to manual techniques. Initial time penalties resolve with experience. Future research should prioritize randomized controlled trials, standardized outcome measures, and cost-effectiveness analyses.