Department of Plastic and Reconstructive Surgery, Korea University Hospital, Seoul, Republic of Korea.
Institute of Nano, Regeneration, Reconstruction, College of Medicine, Korea University, Seoul, Republic of Korea.
Medicine (Baltimore). 2023 May 19;102(20):e33841. doi: 10.1097/MD.0000000000033841.
The RoboticScope (BHS Technologies GmbH, Innsbruck, Austria) is a robotic exoscope, which consists of a robotic arm that holds a 3-dimensional camera. It has an advantage that a surgeon can perform an operation comfortably with a favorable ergonomic position. Also, it allows the delivery of clear and high-quality visualization for surgeons. In this study, we would like to share our initial experience with this newly developed microscope technology in lymphaticovenular anastomosis (LVA). To the best of our knowledge, it is the first experience of LVA using this microscope in Asia.
A 65-year-old woman presented with bilateral lower extremity lymphedema after a hysterectomy that was performed 25 years back. Despite complex decongestive physiotherapy, an edematous symptom in both legs worsened.
In lymphoscintigraphy, a decreased visualization of main lymphatic flow in both the lower extremities was evident which was further suggestive of lymphatic obstruction.
Although both sides showed edematous symptoms, we decided to proceed with the surgery on the left side first, because of the worsened condition. Four LVAs were performed at the dorsum of the foot (×2), ankle, and the superior edge of the knee using RoboticScope.
At 6-months follow-up after operation, the postoperative circumference diameters were improved than preoperative in 10 cm above the knee (45 cm vs 49 cm), 10cm below the knee (37 cm vs 41 cm) and lateral malleolus (25 cm vs 28 cm). The lower extremity lymphedema index was also improved from 346.7 to 287.4 postoperatively. The RoboticScope provided a high-resolution image and a favorable ergonomic position during an operation.
The results represent the possibility of the application of a robotic microscope in the field of microsurgery, and further studies are necessitated to confirm the efficacy of this system.
RoboticScope（奥地利因斯布鲁克的 BHS Technologies GmbH）是一种机器人外窥镜，由一个持三维相机的机器臂组成。它的优点是外科医生可以舒适地采用有利的人体工程学姿势进行手术。此外，它还可以为外科医生提供清晰、高质量的可视化效果。在本研究中，我们希望分享在淋巴血管吻合术（LVA）中应用这种新开发的显微镜技术的初步经验。据我们所知，这是亚洲首次使用该显微镜进行 LVA 的经验。
一位 65 岁的女性在 25 年前进行子宫切除术 25 年后出现双侧下肢淋巴水肿。尽管进行了复杂的消肿物理治疗，但双腿的水肿症状仍在恶化。
淋巴闪烁显像显示双侧下肢主要淋巴流的可视化明显减少，进一步提示存在淋巴阻塞。
尽管两侧都有水肿症状，但由于病情恶化，我们决定先在左侧进行手术。使用 RoboticScope 在足部背侧（×2）、脚踝和膝盖上方进行了 4 次 LVA。
术后 6 个月随访时，手术侧膝关节以上 10cm（45cm 对 49cm）、膝关节以下 10cm（37cm 对 41cm）和外踝（25cm 对 28cm）的术后周长直径均优于术前。下肢淋巴水肿指数也从术前的 346.7 改善至术后的 287.4。RoboticScope 在手术过程中提供了高分辨率的图像和有利的人体工程学姿势。
结果表明，机器人显微镜在显微外科领域的应用具有可能性，需要进一步研究来证实该系统的疗效。
