Brown Hannah, Brown Ryleigh A, Lenkiu Leticia, SamSam Aseela, Lopez Joseph, Sawh-Martinez Rajendra
From the Department of Plastic & Reconstructive Surgery, University of Central Florida, School of Medicine, Orlando, FL.
Milken Institute of Public Health, George Washington University, Washington, DC.
Plast Reconstr Surg Glob Open. 2025 Jul 17;13(7):e6912. doi: 10.1097/GOX.0000000000006912. eCollection 2025 Jul.
Robotic microsurgery is rapidly changing the surgical landscape by mitigating conventional hand-surgical limitations such as physiological tremor while promoting increased precision in confined spaces through the provision of high-depth microoptics and motion-scaling. The innovation of specialized "super" microsurgical robotic platforms such as Medical Microinstruments' Symani and Microsure's MUSA-2 has further bolstered microsurgical toolkits by enabling high-precision microvascular anastomoses in vessels with a diameter of 0.8 mm of less.
Our team conducted a systematic literature review of the global uses of robotic-assisted supermicrosurgery in plastic and reconstructive surgery. Using Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 flow guidelines, our search yielded 107 articles, of which 16 were eligible based on our inclusion criteria.
Our results showed that lymphaticovenous anastomoses represent 37% of reported plastic and reconstructive surgery supermicrosurgery robot clinical uses, whereas free flaps and nerve repairs comprised just 14% and 2%, respectively. These procedures were found to correspond with significant but short learning curves. Across studies, mean operating times were found to be up to 1.5 times greater than manual techniques and showed a downward trend in time spent. Our analysis revealed that robotic-assisted techniques decreased rates of microtrauma, with anastomotic patency rates of 99.38%.
Although robotic technology represents a significant financial investment and includes training needs, current literature supports evidence of potential long-term net savings due to reliably high patency rates; decreased in-hospital recovery times; the promise of new, expanded surgical options and capabilities; and enhanced career longevity for surgeons.
机器人显微外科手术正在迅速改变手术领域，它通过减轻传统手部手术的局限性（如生理震颤），同时通过提供高深度显微光学和运动缩放功能，提高在狭窄空间内的操作精度。诸如Medical Microinstruments公司的Symani和Microsure公司的MUSA-2等专门的“超级”显微外科机器人平台的创新，进一步增强了显微外科手术工具包的功能，能够在直径小于0.8毫米的血管中进行高精度微血管吻合。
我们的团队对机器人辅助超级显微外科手术在整形和重建手术中的全球应用进行了系统的文献综述。根据系统评价和Meta分析的首选报告项目2020流程指南进行检索，共获得107篇文章，其中16篇符合我们的纳入标准。
我们的结果表明，淋巴静脉吻合术占报告的整形和重建手术超级显微外科机器人临床应用的37%，而游离皮瓣和神经修复分别仅占14%和2%。这些手术的学习曲线显著但较短。在各项研究中，平均手术时间比手工技术长1.5倍，且呈下降趋势。我们的分析表明，机器人辅助技术降低了微创伤发生率，吻合通畅率为99.38%。
尽管机器人技术需要大量资金投入且需要培训，但目前的文献支持这样的证据，即由于其可靠的高通畅率、缩短住院恢复时间、有望提供新的、扩展的手术选择和能力以及延长外科医生的职业寿命，可能会带来长期的净节省。
