Robot‐assisted microvascular anastomosis in head and neck free flap reconstruction: Preliminary experiences and results

Abstract

Background The da Vinci Surgical System has facilitated considerable advancements in surgery. The process and results of robot‐assisted microvascular anastomosis in real clinical situations have rarely been reported. This study presents our experience of performing robot‐assisted microvascular anastomosis in free flap reconstruction in patients with oropharyngeal cancer. Patients and methods This was a retrospective study of reconstructive operations using a free radial forearm flap for oropharyngeal defects after tumor extirpation in 15 consecutive adult patients (12 men and 3 women). In total, 17 robot‐assisted microvascular vessel anastomoses (2 arteries and 15 veins) were performed; moreover, 13 arteries and 13 veins were anastomosed using the standard operating microscope and hand‐sewing technique. Results The recipient and donor vessel diameters were 2.5 ± 0.7 and 2.1 ± 0.8 mm, respectively. The donor blood vessel diameter selected for anastomosis using da Vinci Surgical System was significantly smaller (2.1 ± 0.8 vs. 2.5 ± 0.6 mm) than that for a standard operating microscope and hand‐sewing technique (p = .021), the operating time spent (38.4 ± 10.4 vs. 28.0 ± 7.7 min) was significantly longer (p < .001). The vascular patency rate was 100%, and all flaps survived without requiring additional operation for revision. Conclusion Robotic surgical systems can facilitate vascular microanastomosis and provide a blood vessel patency rate comparable to that of a standard operating microscope and hand‐sewing technique.

Does plastic surgery need a rewiring? A survey and systematic review on robotic-assisted surgery

“… 27 , 34 Lai et al (2019) noted equal outcomes for both RAS and non-RAS, but also reported that the RAS group used significantly smaller vessels for microanastomosis than non-RAS. 28 Similarly, another study demonstrated that RAS improved some lymphedema-related symptoms more than non-RAS following surgical intervention for breast cancer-related lymphedema. 30 …”

“…The average age among the study groups was 50.2 years old. Two studies were retrospective, 28 , 29 one was prospective, 30 and one was a case series. 31 …”

“…Lai et al (2019) conducted a retrospective study of head and neck cancer patients to evaluate RAS microanastomosis. 28 Compared to the standard technique, RAS microanastomosis had a significantly longer operating time. The donor blood vessel diameter in the robot group was significantly smaller than that in the traditional group.…”

“…RAS was used to harvest DIEP flap for breast reconstruction that had no flap loss or abdominal complications, whereas endoscopic harvest elicited two instances of flap loss. 26 Three studies demonstrated no operative complications and flap survival in all patients at final follow-up; 27 , 28 , 33 two of the three studies failed to compare outcomes with traditional cohorts. 27 , 34 Lai et al (2019) noted equal outcomes for both RAS and non-RAS, but also reported that the RAS group used significantly smaller vessels for microanastomosis than non-RAS.…”

Microsurgery in the era of COVID-19

“…Before the COVID-19 pandemic, transoral robotic surgery was gaining widespread use among head and neck oncologic and reconstructive surgeons, 30 with outcomes comparable to those of nonrobotic anastomoses with use of a standard operating microscope. 31 This would allow spatial segregation of the operating surgeon from the high-risk field.…”