A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery—From Inception to the Future

Dobbs, Thomas D.; Cundy, Olivia; Samarendra, Harsh; Khan, Khurram; Whitaker, Iain S.

doi:10.3389/fsurg.2017.00066

Cited by 47 publications

(36 citation statements)

References 92 publications

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“…16 Moreover, scar burden is reduced, as well as postoperative pain and hospital stay. 17 In this robotic-enhanced cadaveric model, we compared performance outcomes of two different approaches for DIEP flap harvest. Although the TAPP approach has less technical features and showed less operative time compared with the TEP approach, it involves all the potential complications related to entering and working in the peritoneal cavity, such as adhesion formation and potential bowel obstruction, as well as bowel injury.…”

Section: Discussionmentioning

confidence: 99%

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Manrique

Bustos

Mohan

et al. 2020

J Reconstr Microsurg

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Background The deep inferior epigastric perforator (DIEP) flap is the most common perforator flap for microsurgical breast reconstruction. Contrary to the conventional open approach, robotic-assisted DIEP flap harvest intends to preserve ARS integrity, thereby reducing the morbidity. We assessed the feasibility and compared performance outcomes of a robotic, cadaveric training model for DIEP flap harvest using two approaches: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). Methods A robotics system (da Vinci Xi) was applied in conjunction with a cadaveric training model. Ports were placed in the abdominal wall to triangulate each DIEP flap. Surgical time and technical characteristics were recorded. Values were analyzed and compared. Results Eight female cadavers (16 hemi-DIEP flaps) were dissected: 50% TAPP and 50% TEP approaches. Mean harvest time was 56 minutes (range: 48–74 minutes) and 65 minutes (range: 60–83 minutes) for TAPP versus TEP groups, respectively (p < 0.05). Mean pedicle dissection time was 36 minutes (range: 25–40 minutes) and 39 minutes (range: 30–42 minutes) for TAPP versus TEP groups, respectively (p > 0.05). Intra-abdominal contents were manipulated twice on average in the TAPP group versus 0 times in the TEP group (p < 0.05). One TAPP case had an injury to the bowel, and one TEP case was converted to conventional open due to pneumoperitoneum. Conclusion Robotic-assisted DIEP flap harvest represents a technological enhancement for advanced regenerative plastic surgery. Our model demonstrated both TAPP and TEP are feasible, with TEP less invasive, preserving the posterior rectus sheath, and decreasing complication risks. However, there is a steeper and longer learning curve for TEP.

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Section: Discussionmentioning

confidence: 99%

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Manrique

Bustos

Mohan

et al. 2020

J Reconstr Microsurg

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“…From literature review, microvascular anastomosis is the most widely-discussed issue, especially in head and neck reconstruction. 20 Different approaches such as muscle flap harvesting, pedicle dissection, lymph-venous anastomosis have also been studied and reported. 16,21 However, the use of robotics in peripheral nerve reconstruction still lacks persuasive evidence.…”

mentioning

confidence: 99%

“…Over the past decade, the potential and feasibility of robotic reconstructive microsurgery has been enthusiastically discussed and the potentialindications have been tried and reported. 19,20 Microsurgery is one of the popular indications for the use of robotics. From literature review, microvascular anastomosis is the most widely-discussed issue, especially in head and neck reconstruction.…”

mentioning

confidence: 99%

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Chen

Goh

Goh³

et al. 2021

J Reconstr Microsurg

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Background Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. Methods A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. Results Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. Conclusion Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.

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“…Neurosurgical procedures using robotics include brachial plexus repair and sympathetic chain repair to treat Horner's syndrome; both concern clinical cases.…”

Section: Applications Of Robotic Microsurgerymentioning

confidence: 99%

Robotic (super) microsurgery: Feasibility of a new master‐slave platform in an in vivo animal model and future directions

Mulken

Schols

Qiu

et al. 2018

Journal of Surgical Oncology

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Advanced microsurgical procedures are currently limited by human precision and manual dexterity. The potential of robotics in microsurgery is highlighted, including a general overview of applications of robotic assistance in microsurgery and its introduction in different surgical specialties. A new robotic platform especially designed for (super) microsurgery is presented. Results of an in vivo animal study underline its feasibility and encourage further development toward clinical studies. Future directions of robotic microsurgery are proposed.

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A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery—From Inception to the Future

Cited by 47 publications

References 92 publications

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Robotic (super) microsurgery: Feasibility of a new master‐slave platform in an in vivo animal model and future directions

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