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Journal of robotic surgery
Dec 17, 2024;19 (1): 28.

Robot-assisted microsurgery: a single-center experience of 100 cases.

F Struebing, A Boecker, F Vollbach, J Weigel, U Kneser, A K Bigdeli, E Gazyakan
Author Information
  1. F Struebing: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  2. A Boecker: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  3. F Vollbach: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  4. J Weigel: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  5. U Kneser: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  6. A K Bigdeli: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
  7. E Gazyakan: Department of Hand, Plastic and Reconstructive Surgery, Department of Hand and Plastic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig Guttmann-Straße 13, 67071, Ludwigshafen, Germany. emre.gazyakan@bgu-ludwigshafen.de.
PMID: 39688744 DOI: 10.1007/s11701-024-02175-3

Abstract

The adoption of robot-assisted microsurgery (RAMS) is a cutting-edge advancement in the realm of microsurgery. The Symani Surgical System is CE approved and has recently gained FDA approval. It provides tremor elimination, motion scaling and improved ergonomics. This study reports on the first 100 consecutive cases of RAMS at a high-volume academic center, representing the largest series to date, and assesses its clinical application and efficacy. A prospective database captured all RAMS cases at a single institution between February 2023 and April 2024. Parameters recorded included patient demographics, surgical details, and outcomes. Surgeons completed a comprehensive 12 h training program to ensure adept use of the system. One-hundred patients with a mean age of 54 yrs were identified, predominantly male (66%). RAMS was performed in a wide range of procedures, notably free flaps (73%), nerve surgery (20%), and lymphovenous anastomoses (LVA) (6%). 159 anastomoses and coaptations were performed. Major complications occurred in 12 cases (12%). There were two complete free flap losses (2.7% of free flaps) and one partial free flap loss (1.4%). LVAs had significantly longer times per stitch than other types of anastomoses (p < 0.01). RAMS presents a viable alternative to traditional microsurgery with a commendable safety profile, marked by a 3% conversion rate to conventional techniques and complication rates that align with current literature. While challenges such as longer anastomosis times and higher costs exist, the results affirm the feasibility of RAMS in a high-volume microsurgical center.

Keywords

Free flap surgery Plastic surgery Reconstructive surgery Robot-assisted microsurgery Robotic microsurgery Supermicrosurgery

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MeSH Term

Humans
Robotic Surgical Procedures
Microsurgery
Middle Aged
Male
Female
Adult
Aged
Operative Time
Anastomosis, Surgical
Free Tissue Flaps
Treatment Outcome
Prospective Studies
Postoperative Complications
Journal Article

Word Cloud

Created with Highcharts 10.0.0RAMSmicrosurgerycasesfreesurgeryanastomosesflap100high-volumecenterperformedflapslongertimesRobot-assistedadoptionrobot-assistedcutting-edgeadvancementrealmSymaniSurgicalSystemCEapprovedrecentlygainedFDAapprovalprovidestremoreliminationmotionscalingimprovedergonomicsstudyreportsfirstconsecutiveacademicrepresentinglargestseriesdateassessesclinicalapplicationefficacyprospectivedatabasecapturedsingleinstitutionFebruary2023April2024ParametersrecordedincludedpatientdemographicssurgicaldetailsoutcomesSurgeonscompletedcomprehensive12 htrainingprogramensureadeptusesystemOne-hundredpatientsmeanage54 yrsidentifiedpredominantlymale66%widerangeproceduresnotably73%nerve20%lymphovenousLVA6%159coaptationsMajorcomplicationsoccurred1212%twocompletelosses27%onepartialloss14%LVAssignificantlyperstitchtypesp < 001presentsviablealternativetraditionalcommendablesafetyprofilemarked3%conversionrateconventionaltechniquescomplicationratesaligncurrentliteraturechallengesanastomosishighercostsexistresultsaffirmfeasibilitymicrosurgicalmicrosurgery:single-centerexperienceFreePlasticReconstructiveRoboticSupermicrosurgery

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