Incorporation of new technologies advances surgery in general. One example is robot assistance which can potentially overcome limitations in accessibility, dexterity, and ergonomics, thereby improving outcome of surgical procedures. To date, robot assistance has been used successfully in various fields of surgery. Also, in microsurgery robot assistance could offer great advantages as it requires great precision and meticulous technique. Currently available surgical robotic platforms are primarily designed for endoscopic procedures and lack the specific requirements for true microsurgery. Therefore, plastic surgeons of the Maastricht University Medical Center (Maastricht, the Netherlands) teamed up with engineers from the Eindhoven University of Technology (Eindhoven, the Netherlands) and developed the first dedicated robotic platform for (super)microsurgery, the MicroSure Robot (MSR). Level of evidence: Level V, therapeutic study.

Innovative techniques can help overcome the limitations of the human body. Operating on very small structures requires adequate vision of the surgical field and precise movements of sophisticated instruments. Both the human eye and hand are limited when performing microsurgery. Conventional microsurgery uses operation microscopes to enhance the visualization of very small structures. Evolving technology of high-definition 3D cameras provides the opportunity to replace conventional operation microscopes, thereby improving ergonomics for surgeons. This leaves the human hand as a limiting factor in microsurgery. A dedicated robot for microsurgery has been developed to overcome this limitation and enhance the precision and stability of the surgeons’ hands. We present the first-in-human case in reconstructive microsurgery where both technologies are integrated using a dedicated microsurgical robot in combination with a 4K 3D exoscope.