Preclinical Performance of the Combined Application of Two Robotic Systems in Microsurgery: A Two-center Study

Wessel, Kai J.; Stögner, Viola A.; Yu, Catherine T.; Pomahac, Bohdan; Hirsch, Tobias; Ayyala, Haripriya S.; Kueckelhaus, Maximilian

doi:10.1097/gox.0000000000005775

Cited by 8 publications

(1 citation statement)

References 24 publications

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“…It offers wristed microsurgical and supermicrosurgical instruments, adding distal motion axes for an improved range of motion compared to conventional microsurgical instruments. Several preclinical studies revealed improved precision and ergonomics upon application of the Symani for the performance of microvascular anastomoses in vitro [ 1 – 3 ] and in vivo [ 4 ]. Furthermore, feasibility and safety of robot-assisted microsurgery was demonstrated in multiple initial clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Ideal suturing technique for robot-assisted microsurgical anastomoses

Wessel,

Wendenburg,

Varnava

et al. 2024

J Robotic Surg

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The development of novel robotic devices specifically designed for open microsurgery leads to increasing applications in reconstructive procedures. While initial studies revealed improved precision and surgical ergonomics upon robotic assistance, surgical time was consistently observed to be increased. This study compares two robotic suturing techniques using the Symani Surgical System and RoboticScope in a preclinical setting, to further leverage the benefits of novel robotic devices in microsurgery. Six experienced microsurgeons performed three microvascular anastomoses with a “steady-thread” suturing technique and a “switch-thread” technique on 1.0-mm-diameter artificial silicone vessels. Time for anastomosis and participant’s satisfaction with the techniques and robotic setup were recorded. Anastomosis quality and microsurgical skills were assessed using the Anastomosis Lapse Index and Structured Assessment of Microsurgery Skills. Lastly, technical error messages and thread ruptures were quantified. Knot tying was significantly faster and evaluated significantly better by participants using the steady-thread technique (4.11 ± 0.85 vs. 6.40 ± 1.83 min per anastomosis). Moreover, microsurgical skills were rated significantly better using this technique, while both techniques consistently led to high levels of anastomosis quality (2.61 ± 1.21 vs. 3.0 ± 1.29 errors per anastomosis). In contrast, the switch-thread technique was associated with more technical error messages in total (14 vs. 12) and twice as many unintended thread ruptures per anastomosis (1.0 ± 0.88 vs. 0.5 ± 0.69). This study provides evidence for the enhanced performance of a steady-thread suturing technique, which is suggested to be applied upon robot-assisted microsurgical procedures for optimized efficiency.

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Section: Introductionmentioning

confidence: 99%

Ideal suturing technique for robot-assisted microsurgical anastomoses

Wessel,

Wendenburg,

Varnava

et al. 2024

J Robotic Surg

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Learning curve of robotic assisted microsurgery in surgeons with different skill levels: a prospective preclinical study

von Reibnitz,

Weinzierl,

Grünherz

et al. 2024

J Robotic Surg

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Achieving precision in microsurgery requires skill, adequate instruments and magnification, as well as extensive training. Dedicated surgical robotic systems have enhanced and expanded the application of (super-)microsurgical techniques by introducing motion scaling and providing improved surgeon ergonomics. In this prospective preclinical trial, we analyzed the learning curve in robotic assisted microsurgery in 13 participants including medical students, residents, and attending physicians. Data on demographics as well as prior experience in surgery, microsurgery, and gaming were collected. In three study sessions, the participants performed nine microsurgical anastomoses each on 2 mm vessel models using the Symani® Surgical System in combination the VITOM 3D exoscope. A senior expert microsurgeon reviewed the de-identified and blinded videos and scored all anastomoses using a modified “Structured Assessment of Microsurgical Skills” (SARMS) score. All participants significantly reduced their time needed per anastomosis and their overall SARMS score, as well as individual scores for motion and speed throughout the trial. We saw a significant correlation of prior years of practice in surgery with the overall mean time and mean SARMS score. In a separate analysis of the three sessions, this influence could no longer be seen in the last session. Furthermore, we found no significant effect of gender, age, hand dominance, or gaming experience on speed and quality of the anastomoses. In this study of 117 robotic assisted anastomoses, a rapid improvement of performance of all participants with different surgical skills levels could be shown, serving as encouraging evidence for further research in the implementation of microsurgical robotic systems.

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Robotic-Assisted Microsurgery in Gender-Affirming Phalloplasty

Wellenbrock,

Ozturk,

Sohn

et al. 2024

Ann Plast Surg

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Genital gender-affirming masculinization surgeries require handling of small vessels and nerves handling in deep planes. Since the introduction of the Symani Surgical System for robotic-assisted microsurgery in clinical practice, its value in handling small and deep vessels via additional distal motion axes, motion scaling, and tremor elimination has been demonstrated. We combined the Symani with the robotic exoscope RoboticScope to achieve maximum flexibility and ergonomics for the microsurgeon. Here, we present the initial application of robotic-assisted microsurgery for gender-affirming phalloplasty. The Symani and the RoboticScope were used to perform the end-to-side nerve coaptation of the lateral antebrachial cutaneous nerve to the dorsal nerve of the clitoris with five epineural 9.0 Ethilon sutures. Arterial anastomosis to the deep inferior epigastric artery (DIEA) was completed in an end-to-end fashion with six 8.0 Ethilon sutures. Cephalic vein anastomosis to the great saphenous vein was performed manually in an end-to-end fashion using a 3.5-mm coupler. The time for nerve coaptation was 17 minutes; for arterial anastomosis, 26 minutes; and for vein anastomosis, 6 minutes. Time for flap ischemia was 157 minutes. Incision to closure was performed in 401 minutes. Symani's tremor elimination and motion scaling support precise arterial anastomosis and nerve coaptation. The additional degrees of freedom distal to the tips of the instruments enable flexible operation in deep planes, such as the periclitoral space. Combining Symani with a robotic exoscope enables a comfortable remote positioning for the surgeon. The presented case demonstrates feasibility and encourages further exploration to elucidate the potential benefits of this robotic-assisted technique.

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Preclinical Performance of the Combined Application of Two Robotic Systems in Microsurgery: A Two-center Study

Cited by 8 publications

References 24 publications

Ideal suturing technique for robot-assisted microsurgical anastomoses

Ideal suturing technique for robot-assisted microsurgical anastomoses

Learning curve of robotic assisted microsurgery in surgeons with different skill levels: a prospective preclinical study

Robotic-Assisted Microsurgery in Gender-Affirming Phalloplasty

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