Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Munster, Munster, Germany.
Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Munster, Germany.
Microsurgery. 2024 Sep;44(6):e31227. doi: 10.1002/micr.31227.
Recently, there is an ongoing trend in plastic surgery with robotic-assisted microsurgery and supermicrosurgery devices being developed. Combining a telemetrically controlled robotic microscope with an also telemetrically controlled microsurgery robot unlocks synergistic effects with complete disconnection of the operating surgeon from the operating field. Here, we report the first clinical free flap reconstructions using this setup.
Twenty-three surgeries were performed with the combined remote approach using the Symani Surgical System and the RoboticScope in open microsurgery procedures. Anastomosis time and ischemia time were recorded. The surgical performance for anastomoses was assessed using the modified Structured Assessment of Microsurgical Skills (SAMS) score. Subjective satisfaction was evaluated by the surgeons in comparison with conventional microsurgery. To evaluate the learning curve, the senior authors first four (first group) and last four (last group) procedures were compared.
Overall, flap survival was 95.7%. The average arterial anastomosis time was 36.7 ± 10.9 min. Total time of surgery was 277.7 ± 63.8 min, and ischemia time was 100.6 ± 24.9 min. Most SAMS score parameters were significantly higher in the last group of surgical procedures compared with the first operations. Subjective satisfaction was equal or better with the combined robotic-assisted approach in most categories.
Our data demonstrates safety and feasibility of the use of a combined remote approach. Robotic systems for microsurgical procedures may hold promising potential for improvement of surgical quality and open up new frontiers in microsurgery.
最近，在整形外科学领域出现了一种新趋势，即开发机器人辅助微创手术和超微创手术设备。通过将遥测控制的显微镜与遥测控制的微创手术机器人相结合，可以实现协同效应，使手术医生完全与手术区域隔离。在此，我们报告首例使用该设备进行游离皮瓣重建的临床案例。
在 23 例开放性显微手术中，使用 Symani 手术系统和 RoboticScope 进行了联合远程手术。记录吻合时间和缺血时间。使用改良的显微外科技能结构化评估（SAMS）评分评估吻合的手术表现。与传统显微外科相比，外科医生评估主观满意度。为了评估学习曲线，资深作者比较了前 4 例（第 1 组）和后 4 例（第 2 组）手术。
总的来说，皮瓣存活率为 95.7%。平均动脉吻合时间为 36.7±10.9 分钟。手术总时间为 277.7±63.8 分钟，缺血时间为 100.6±24.9 分钟。与第 1 组手术相比，最后一组手术的大多数 SAMS 评分参数明显更高。在大多数类别中，联合机器人辅助方法的主观满意度相等或更高。
我们的数据表明，联合远程方法的使用具有安全性和可行性。用于显微手术的机器人系统可能具有提高手术质量的巨大潜力，并为显微外科开辟新的领域。
