Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
Department of Plastic Surgery, Royal Free Hospital, London, UK.
Microsurgery. 2024 Nov;44(8):e31246. doi: 10.1002/micr.31246.
Microsurgery and super-microsurgery allow for highly technical reconstructive surgeries to be performed, with repairs of anatomical areas of less than 1 mm. Robotic-assisted surgery might allow for further advances within microsurgery, providing higher precision, accuracy, and scope to operate in previously inaccessible anatomical areas. However, robotics is not well-established within this field. We provide a summary of the clinical and preclinical uses of robotics within flap reconstruction and microsurgery, educational models, and the barriers to widespread implementation.
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted of PubMed, Medline, and Embase. Preclinical, educational, and clinical articles were included.
One thousand five hundred and forty-two articles were screened; 87 articles met the inclusion criteria across flap harvest, flap/vessel pedicle dissection, vascular anastomosis, and nerve repair. The literature presents several potential benefits to the surgeon and patient such as high cosmetic satisfaction, minimally invasive access with reduced scarring (flap harvest), and low complication rates. Lack of haptic feedback was reported by authors to not impede the ability to perform vessel anastomosis; however, this required further investigation. A steep learning curve was identified, particularly for microsurgeons embarking upon robotic-assisted surgery.
Robotic-assisted surgery can potentially enhance microsurgery and flap reconstruction, with feasibility demonstrated within this review, up to anastomosis of 0.4 mm in diameter. However, there is a lack of sufficiently powered comparative studies, required to strengthen this statement. To increase accessibility to robotic surgery for plastic and reconstructive surgeons, educational opportunities must be developed with standardized assessment of skill acquisition.
显微外科和超显微外科使解剖面积小于 1mm 的高难度重建手术得以实施。机器人辅助手术可能会在显微外科领域进一步发展，提供更高的精度、准确性和操作范围，以进入以前无法触及的解剖区域。然而，机器人技术在该领域尚未得到广泛应用。我们总结了机器人在皮瓣重建和显微外科、教育模型中的临床和临床前应用，以及广泛应用的障碍。
按照系统评价和荟萃分析的首选报告项目，对 PubMed、Medline 和 Embase 进行了系统评价。纳入了临床前、教育和临床文章。
筛选出 1542 篇文章；87 篇文章符合皮瓣采集、皮瓣/血管蒂解剖、血管吻合和神经修复的纳入标准。文献提出了一些对术者和患者的潜在益处，如高美容满意度、微创入路和减少疤痕（皮瓣采集）以及低并发症发生率。作者报告称，缺乏触觉反馈并不妨碍进行血管吻合的能力；然而，这需要进一步调查。发现显微外科医生在开始机器人辅助手术时存在陡峭的学习曲线。
机器人辅助手术可能会增强显微外科和皮瓣重建，本综述证明了在直径为 0.4mm 的吻合方面具有可行性。然而，缺乏足够有力的对照研究来加强这一说法。为了让整形和重建外科医生更容易获得机器人手术，必须开发教育机会，并对技能获取进行标准化评估。
