Challenges of Robot-Assisted Surgery in Reconstructive Microsurgery: A Scoping Review

Robotic platforms have been popularized in reconstructive microsurgery for their ability to enhance precision and dexterity, filter tremor, and reduce surgical fatigue. Nonetheless, implantation challenges compared with conventional methods remain poorly synthesized. This scoping review identifies common barriers to robotic platforms in reconstructive microsurgery.

A literature search was conducted in PubMed (Medline), Embase, and the Cochrane Library for English-language publications between January 1, 2016 and September 30, 2026 reporting clinical challenges in robot-assisted surgical reconstruction. Publications included were primary research. Reviews and preclinical studies were excluded. A total of 726 articles were screened, and 30 met the inclusion criteria.

Thirty peer-reviewed publications were reviewed, predominantly from European and American institutions utilizing the Da Vinci Surgical System, Medical Microinstrument's Symani Surgical System, or MicroSure's MUSA surgical robots. Most consistently reported challenges were prolonged operative and anastomotic times in 83% of studies, increased operative costs in 57% of studies, learning and adaptation to robot-assisted microsurgery, as well as a lack of haptic feedback and complex operating room set-up. Less commonly reported barriers include instrument reliability, physiological motion impairing operative control, large robotic footprint, sustainability of single-use consumables, limited operative field, and magnetic interference. Inconsistent reporting on the learning curve of robot-assisted surgery was noted. Overall, the evidence base is limited by conflicts of interest with robotic manufacturers present within 37% of reviewed studies, small sample sizes, methodological heterogeneity, and paucity of long-term patient outcomes. These limitations may underestimate the challenges surgeons face in adopting robotic platforms in reconstructive microsurgery.

Robot-assisted reconstructive microsurgery is a promising but maturing field. Future research should include manual microsurgical control groups and report long-term clinical outcomes to strengthen the evidence base for robot-assisted reconstructive microsurgery. Randomized controlled trials with manual control groups will help guide the standardization of robot-assisted microsurgery training curricula.