Expanding the Role of Robot-assisted Microsurgery: Implementation, Challenges, and Outlook From a High-volume...

Robot-assisted microsurgery (RAMS) extends conventional microsurgical techniques by enhancing precision, eliminating tremor, and providing motion scaling. Despite its promising role in plastic and reconstructive surgery, its clinical implementation remains limited. Recent advancements, notably the Symani Surgical System, address prior challenges in scale and dexterity, enabling interventions in challenging anatomical regions. This study shares our single-center experience using RAMS across diverse reconstructions and assesses its implementation, feasibility, and short-term outcomes.

We retrospectively analyzed 40 consecutive RAMS procedures between March 2023 and April 2024 performed by a single surgeon at a high-volume tertiary care center using the Symani Surgical System. Patient demographics, surgical details, and outcomes were systematically collected.

Forty patients underwent robot-assisted reconstructions; 26 cases involved free tissue transfer and 14 acute hand trauma, including digital replantations. Two cases involved lymphovenous anastomoses, either combined with or preformed separately from lymph node transfer. A total of 130 robot-assisted anastomoses were performed: 43 arterial anastomoses, 57 venous anastomoses, 7 vein-to-artery anastomoses, 4 lymphovenous anastomoses, and 19 nerve coaptations. No flap loss or revisions occurred. Mean anastomosis time was approximately 16.4 minutes (±9.6 min).

RAMS demonstrated safety, feasibility, and favorable clinical outcomes in a variety of reconstructive cases. Although initial challenges such as prolonged operative times and elevated costs persist, these decline with experience and familiarity. RAMS holds potential for broader clinical integration and future applications, including remote microsurgery. Further studies should evaluate its long-term outcomes, cost-effectiveness, and routine application.