Evaluation of microsurgical free flap procedures utilizing the Symani Surgical System: A preliminary analysis

Abstract

BACKGROUND: Robotic assistance in microsurgery represents a promising field with the potential to enhance precision and outcomes. This study evaluates the first twelve microsurgical procedures performed at Department of Plastic Surgery at Odense University Hospital using the Symani Surgical System. METHODS: From January 4th to April 11th, 2024, twelve microsurgical procedures were performed with the Symani Surgical System by two experienced microsurgeons. The procedures included anterolateral thigh flaps (ALT flaps), deep inferior epigastric perforator flaps (DIEP flaps), fibular free flaps (Fib flaps), helical flap, and lymphovenous anastomosis (LVA). Data collected included ischemic time, time of anastomosis, patient age and gender, indication for operation, type of operation, and number of microsurgery stitches. Post-procedure, surgeons were interviewed regarding the benefits and limitations of using the Symani Surgical System. RESULTS: The use of the Symani Surgical System effectively reduced tremor, significantly aiding super-microsurgery (< 0.8 mm). While experienced surgeons found limited value in regular microsurgery (> 0.8 mm), the system provided substantial assistance in super-microsurgery. However, challenges included ergonomic discomfort due to constrained operating positions and difficulty in adapting to respiratory and cardiac movements, relevant when performing DIEP flaps. The interviews highlighted that while the technology simplifies microsurgery for novices, but it may reduce experience in conventional manual techniques if not addressed. CONCLUSION: The Symani Surgical System offers significant benefits in tremor reduction and precision, particularly in super-microsurgery. Despite ergonomic and spatial challenges, the potential of robotic assistance in microsurgery is substantial. Ensuring comprehensive training in both robotic and conventional microsurgery is essential.