First-in-Human Free Flap Tissue Reconstruction Using a Dedicated Microsurgical Robotic Platform

Background: Microsurgery has become standard of care for increasingly complex techniques in tissue harvest, replantation, reconstruction, allotransplantation, and supermicrosurgery on submillimetric vessels. As techniques become more challenging and are performed at smaller and smaller scale, there is greater potential application for robotic assistance in extreme motion scaling and tremor reduction. Methods: The Symani Surgical System (Medical Microinstruments, S.p.A, Calci, Pisa, Italy), a robotic platform designed for microsurgery, was used in a robot-assisted microsurgical free flap reconstruction using a perforator-to-perforator flap technique. This procedure utilized robot-assisted anastomosis of an artery and vein. Results: The procedure was completed successfully, with vessels fully patent immediately following and 20 minutes after anastomosis. The flap was viable, no re-exploration of the anastomosis was necessary postoperatively, and no flap loss occurred. Conclusions: This novel, dedicated robotic platform with wristed microsurgical instruments was shown to be feasible for carrying out robot-assisted anastomosis of veins and arteries less than 0.8 mm in diameter, in the domain of supermicrosurgery. The system has the potential to open the field of microsurgery to new clinicians and to facilitate new microsurgical applications that were previously rendered inaccessible by the limits of manual precision and physiological tremor.