Barbon Carlotta, Grünherz Lisanne, Uyulmaz Semra, Giovanoli Pietro, Lindenblatt Nicole
Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
JPRAS Open. 2022 Sep 10;34:126-133. doi: 10.1016/j.jpra.2022.09.002. eCollection 2022 Dec.
Robotic systems have recently been introduced into micro- and supermicrosurgery showing potential benefits for reconstructive surgery. After showing the feasibility and safety of using the Symani Surgical System® for lymphatic microsurgical procedures in humans, we present the results of the first twenty-two patients operated with the robot. The main goal of the study was to determine the learning curve using the Symani Surgical System® . In addition, we aimed at exploring the potential of robot-assisted anastomosis for lymphatic, free flap, and nerve reconstruction and defining the advantages and drawbacks of implementing the system into our daily routine. The operating times were compared between robotic-assisted and hand-sewn anastomoses. Moreover, outcomes and complications were recorded. In this first patient series, anastomotic times were significantly faster with the hand-sewn technique (14.1±4.3 min) when compared with the robot-assisted technique (25.3±12.3 min; p<0.01). However, the learning curve was very steep, and the time needed to perform the anastomosis has been consistently decreasing over time to the point where in the last operations, the times to perform particularly lympho-venous anastomoses were comparable between the two groups. Based on our experience up to date, robot-assisted surgery shows a promising potential in opening up new frontiers in reconstructive microsurgery, e.g., the reliable performance of anastomoses on even smaller blood and lymphatic vessels or on structures deeper within the body cavities, e.g., the thoracic duct.
机器人系统最近已被引入显微和超显微手术，显示出对重建手术的潜在益处。在证明使用Symani Surgical System®进行人体淋巴显微手术的可行性和安全性后，我们展示了首批22例使用该机器人进行手术的患者的结果。本研究的主要目标是确定使用Symani Surgical System®的学习曲线。此外，我们旨在探索机器人辅助吻合在淋巴、游离皮瓣和神经重建方面的潜力，并确定将该系统应用于我们日常手术中的优缺点。比较了机器人辅助吻合和手工缝合吻合的手术时间。此外，记录了手术结果和并发症。在这第一个患者系列中，与机器人辅助技术（25.3±12.3分钟；p<0.01）相比，手工缝合技术的吻合时间（14.1±4.3分钟）明显更快。然而，学习曲线非常陡峭，随着时间的推移，进行吻合所需的时间一直在持续减少，到最后手术时，两组进行特别的淋巴静脉吻合的时间已相当。根据我们目前的经验，机器人辅助手术在开拓重建显微手术的新领域方面显示出有希望的潜力，例如在更小的血管和淋巴管或体腔内更深结构（如胸导管）上可靠地进行吻合。
