Abstract
Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within this surgical subspeciality.
Highlights
Progressive changes in robotic and computer-guided systems have significantly altered operating practice across different medical and surgical specialties
Analysis of all papers in our review revealed that the 53% (n = 20) of papers that utilised surgical robotic systems during microsurgical procedures are feasibility studies
The majority of studies considered in this review are case reports or small case series with less than five patients. These provide valuable insight into important aspects of plastic surgery, such as microvascular anastomosis and nerve repair that form the basis of complex reconstruction. This may act as a stepping stone to conduct further research into surgical robotics in reconstructive microsurgery on a larger scale, this has not yielded in publication of larger studies
Summary
Progressive changes in robotic and computer-guided systems have significantly altered operating practice across different medical and surgical specialties. Surgical robots can extend the capabilities of surgeons by reducing fine tremors, increasing manual dexterity and offering real-time 3D visualisation during endoscopic surgery [1, 2]. This allows for highly precise movement in narrow and difficult-toaccess spaces, and subsequently opens the door for minimally invasive surgery (Figure 1). In addition to enhancing surgical skills and improving ergonomics during surgery, minimally invasive surgery is associated with shorter hospitalisation and reduced risk of adverse complications [3, 4]. Numerous companies are focusing on Limitations of Robotic Plastic Microsurgery
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