The journey of creating the first dedicated platform for robot-assisted (super)microsurgery in reconstructive surgery

Abstract

Incorporation of new technologies advances surgery in general. One example is robot assistance which can potentially overcome limitations in accessibility, dexterity, and ergonomics, thereby improving outcome of surgical procedures. To date, robot assistance has been used successfully in various fields of surgery. Also, in microsurgery robot assistance could offer great advantages as it requires great precision and meticulous technique. Currently available surgical robotic platforms are primarily designed for endoscopic procedures and lack the specific requirements for true microsurgery. Therefore, plastic surgeons of the Maastricht University Medical Center (Maastricht, the Netherlands) teamed up with engineers from the Eindhoven University of Technology (Eindhoven, the Netherlands) and developed the first dedicated robotic platform for (super)microsurgery, the MicroSure Robot (MSR). Level of evidence: Level V, therapeutic study.

Microsurgery Robots: Applications, Design, and Development

“…The MicroSure's MUSA was developed by Maastricht University Medical Center in collaboration with Eindhoven University of Technology, which is the world's first dedicated robotic platform for (super)microsurgery [254]. The MUSA is designed to aid in stabilizing movements of the microsurgeon by filtering tremors and scaling down motions.…”

“…The slave arm of the system has a total of seven degrees of freedom, with six degrees of freedom for positioning and orientation and one degree of freedom for actuating microsurgical instruments. The MUSA is a lightweight, small-sized system providing easy integration in the operating room with minimal adaptations of the room layout and organizational planning [254]. The system, as a master-slave platform, is based on a modular design, permitting it to be used in different configurations depending on the level of required robot assistance, which enables a quick switch between conventional manual mode and robot-assisted mode.…”

A novel encountered‐type master device with precise manipulation for robot‐assisted microsurgery

“…1,2 When using microsurgical tools, the human hand can achieve a precision of approximately 100 μm under optimal conditions as a result of physiological tremors, 3 but it may be dramatically reduced by fatigue, aging, and state of mind. 4 These limitations of precision in manual manipulations limit the microsurgical procedures that humans can perform. 5 In addition, when unfavorable ergonomics are encountered during microsurgery, it becomes difficult to perform precise movements.…”

“…In microsurgery, surgeons deal with fine and delicate tissues ranging from 1 μm to hundreds of μm, so accurate and precise movement of the microsurgical instrument tip is very important 1,2 . When using microsurgical tools, the human hand can achieve a precision of approximately 100 μm under optimal conditions as a result of physiological tremors, 3 but it may be dramatically reduced by fatigue, aging, and state of mind 4 . These limitations of precision in manual manipulations limit the microsurgical procedures that humans can perform 5 …”

Regenerative assisted microsurgery (RAM) and regenerative assisted supermicrosurgery (RASM): the future of microsurgery?

“…However, it is my modest opinion that we are rapidly approaching the physical limits of human dexterity and skill and that probably other strategies will soon have to be considered in order to further extend the horizons of this exciting specialty. The use, for example, of nanotechnologies applied to micro-robotics assistance designed to aid in stabilizing movements of the microsurgeon by filtering tremors and scaling down motions probably help overcome these human limitations, thereby enabling a breakthrough in supermicrosurgery able to further push its limits [ 7 ]. However, beyond these potential and future technical evolutions, I am firmly convinced that the use of advanced and targeted regenerative strategies can be of great benefit to improve and standardize the outcomes of this type of surgery.…”