Stögner Viola A, Pucciarelli Dean M, Pomahac Bohdan, Ayyala Haripriya S
Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT.
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Burn Center, Hannover, Germany.
J Craniofac Surg. 2025;36(1):359-362. doi: 10.1097/SCS.0000000000010608. Epub 2024 Sep 16.
Lymphatic reconstruction entails microsurgery of the smallest human vessels with little microsurgical error tolerance. Surgical outcomes are therefore tightly tied to microsurgical performances and can be restricted by physiologic tremor or muscle tiring throughout extensive procedures. Recently introduced highly specialized microsurgical robots are promising to help overcome these human limitations, particularly relevant for lymphatic microsurgery. Ideal indications and setups for these robotic systems, however, are not yet well established. Reviewing the first 5 years of clinical experience with these microsurgical robots revealed a total of 204 robotically performed lymphatic anastomoses. Most reported use cases (84.4%) involved microsurgical reconstructions of lymphatic flow at the upper and lower extremities, of which 42% of patients were treated for breast cancer-related lymphedema. Considering rising cancer incidences and survival rates, these numbers highlight the potential of robotic-assisted microsurgery for this patient group, whereas the concept of robotic-assisted microsurgery per se can aid surgeons to achieve a new level of microsurgical excellence.
淋巴重建需要对人体最小的血管进行显微手术，对显微手术误差的容忍度很低。因此，手术结果与显微手术操作紧密相关，并且在整个冗长的手术过程中可能会受到生理震颤或肌肉疲劳的限制。最近推出的高度专业化显微手术机器人有望帮助克服这些人类局限性，这对于淋巴显微手术尤为重要。然而，这些机器人系统的理想适应症和设置尚未完全确立。回顾这些显微手术机器人的头5年临床经验，共发现204例机器人辅助下的淋巴吻合术。大多数报告的用例（84.4%）涉及上肢和下肢淋巴流的显微手术重建，其中42%的患者因乳腺癌相关淋巴水肿接受治疗。考虑到癌症发病率和生存率的上升，这些数字凸显了机器人辅助显微手术对该患者群体的潜力，而机器人辅助显微手术本身的概念可以帮助外科医生达到一个新的显微手术卓越水平。
