Robotic Microsurgery in Plastic and Reconstructive Surgery: A Literature Review

Abstract

Background Surgical robots have innovated the microsurgical field by providing advantages that improve surgical performance. These robots have been adopted by certain specialties more than others. This study discusses the potential advantages of robotics in plastic and reconstructive surgery. Method This study is a literature review of articles investigating “robotic microsurgery in plastic and reconstructive surgery” using the PubMed database and the Cochrane Library. Result A total of nineteen relevant articles were found and 5 articles performed a direct comparison between the robotic and manual approaches. Longer operating times were reported in the robotic groups featuring higher learning curves. Reported advantages to robotic use included higher accuracy, precision and flexibility, elimination of tremor and improvement of ergonomic factors. Conclusion While the results provide an outlook into the outcome of robotic platforms in this field, current research is limited and further studies are required to provide a fundamental analysis.

Robot-assisted Microsurgery: Lessons Learned from 50 Consecutive Cases

“…[9][10][11] A 2023 literature review of all articles investigating robotic microsurgery in plastic surgery highlighted the gap in the literature with only 19 relevant articles identified, of which only five directly compared the robotic and conventional approaches. 12 The majority of these studies were preclinical animal studies or case reports. Furthermore, only three of the clinical studies reported on more than five patients, and so far, no larger prospective trials have been published.…”

Future of autologous breast reconstruction: a review of novel technological innovations

“…Addressing the need for more specialized technology in microsurgery, two main robotic systems have come onto the market: MicroSure's MUSA (MicroSure, Eindhoven, Netherlands) [Figure 3A] and the MMI Symani robotic platform (Medical Microinstruments, Pisa, Italy) [Figure 3B]. In a landmark procedure by Innocenti et al in 2021, the Symani platform was used for the first-in-human free flap tissue reconstruction [21] . Both systems are designed to stabilize and scale down movements while filtering tremors.…”

“…The software captures and interprets various pixel ICG intensities over time and transforms this data to automatically label and characterize tissue quality [44,45] . This AI application could be further utilized in autologous breast reconstruction to assess perfusion and potentially detect ; (B) Schematic drawing of MMI Symani robotic platform (Medical Microinstruments, Pisa, Italy) [21] .…”

“…Previous attempts employed technologies like the Da Vinci robotic system, but fell short due to lack of suitability for meticulous microsurgical procedures. As the realm of biotechnology expands, robotic platforms specific to microsurgery will enable optimization of techniques, providing new opportunities to improve breast reconstruction procedures [21,22] .…”

“…While significant clinical experience confers some accuracy, clinical judgment alone falls short at times in identifying inadequate flap perfusion [24] . Recent technologies to be implemented for flap perfusion assessment include indocyanine green (ICG) fluorescence angiography and hyperspectral imaging (HSI) [21,25,26] .…”