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

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

doi:10.1097/GOX.0000000000005775

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

Plast Reconstr Surg Glob Open. 2024 Apr 29;12(4):e5775. doi: 10.1097/GOX.0000000000005775. eCollection 2024 Apr.

Authors

Kai J Wessel¹, Viola A Stögner^{2

3}, Catherine T Yu², Bohdan Pomahac², Tobias Hirsch¹, Haripriya S Ayyala², Maximilian Kueckelhaus¹

Affiliations

¹ From the Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany.
² Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Conn.
³ Hannover Medical School, Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover, Germany.

Abstract

Background: Recent advancements in the development of robotic devices increasingly draw the attention toward the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial.

Methods: Six novices, residents, and experienced microsurgeons (n = 18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the anastomosis lapse index score, microsurgical skills using the Structured Assessment of Microsurgery Skills score, and surgical ergonomics using the Rapid Entire Body Assessment score.

Results: All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, whereas satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with fewer microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared with conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants.

Conclusions: The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. This two-center trial provides promising evidence for a steep learning curve upon introduction of robotic microsurgery systems, suggesting further pursuit of their clinical integration.