Nerve Transfers Using a Dedicated Microsurgical Robotic System

Abstract

Summary: Microsurgical demands in peripheral nerve surgery are increasing. Because of the development of multiple simultaneous selective nerve transfers, the transposition of very small nerves and even single fascicles has evolved. Coaptation of these increasingly smaller structures require high skills in microsurgical techniques. In addition, the surgical situs often has very limited access and is difficult to reach with conventional microsurgical options. Robot technology, the Symani Surgical System (Medical Microinstruments, S.p.A, Calci, Pisa, Italy), was used for epineural coaptation of three donor nerves (intercostal nerves 4–6) to the long thoracic nerve and the thoracodorsal nerve as recipient nerves in a patient with brachial plexus palsy. The coaptations could be carried out successfully with the microsurgical robot technology. In combination with a high-magnification (up to 26×) 3D-exoscope, the epineural sutures could be placed very precisely and accurately. Using this new microsurgical robotic system, successful coaptation of very small nerve structures is possible. This opens possibilities for the microsurgeon to carry out even finer, more targeted and more complex nerve transfers, including procedures in anatomical regions that are difficult to reach.

Robotic-Assisted Anastomosis in Orthoplastic Surgery: Preliminary Data

“…In the future this technology has the potential to increase the accuracy during complex open operations across many different specialties requiring submillimeter precision beyond plastic surgery. [10] We believe that in the future, this technology has the potential to enhance accuracy during complex open procedures across a broad spectrum of specialties, extending beyond plastic surgery and encompassing disciplines that require submillimeter precision, such as ophthalmology and neurosurgery [11][12][13].…”

100 anastomoses: a two-year single-center experience with robotic-assisted micro- and supermicrosurgery for lymphatic reconstruction

“…Single cases and small case series of robotic-assisted free flap and lymphatic reconstruction using the Symani ® Surgical System have been published previously [ 2 , 9 – 14 ]. At our institution, we have implemented the Symani ® in a variety of cases including lymphatic and soft tissue reconstruction.…”

Ideal suturing technique for robot-assisted microsurgical anastomoses

“…Thereby, novel areas of robot-assisted procedures are gradually being investigated especially in the field of plastic surgery and microsurgery. The Symani system has already been successfully applied for lymphatic surgery [ 5 – 7 ], reconstructive free flap surgery [ 8 – 12 ] and peripheral nerve surgery [ 13 , 14 ], consistently revealing improved surgical ergonomics and microsurgical precision compared to conventional manual approaches. Importantly, during these procedures, in its current configuration the Symani is only being used for the performance of microsurgical anastomoses, while the whole preparation is performed conventionally.…”

“…Furthermore, feasibility and safety of robot-assisted microsurgery was demonstrated in multiple initial clinical trials. Therefore, successful application of the Symani has been described in the fields of lymphatic surgery [ 5 – 7 ], extremity reconstruction [ 8 – 10 ], autologous breast reconstruction [ 11 , 12 ] and peripheral nerve surgery [ 13 , 14 ].…”