First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial

Tom J M Van Mulken,Ferry B F Schoenmakers,Bjorn Winkens,Raimondo Cau,Rutger M Schols,Shan S Qiu,René R W J Van Der Hulst,Andrea M J Scharmga

doi:10.1038/s41467-019-14188-w

Tom J M Van Mulken, Ferry B F Schoenmakers + Show 6 more

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https://doi.org/10.1038/s41467-019-14188-w

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Advancements in reconstructive microsurgery have evolved into supermicrosurgery; connecting vessels with diameter between 0.3 and 0.8 mm for reconstruction of lymphatic flow and vascularized tissue transplantation. Supermicrosurgery is limited by the precision and dexterity of the surgeon’s hands. Robot assistance can help overcome these human limitations, thereby enabling a breakthrough in supermicrosurgery. We report the first-in-human study of robot-assisted supermicrosurgery using a dedicated microsurgical robotic platform. A prospective randomized pilot study is conducted comparing robot-assisted and manual supermicrosurgical lymphatico-venous anastomosis (LVA) in treating breast cancer-related lymphedema. We evaluate patient outcome at 1 and 3 months post surgery, duration of the surgery, and quality of the anastomosis. At 3 months, patient outcome improves. Furthermore, a steep decline in duration of time required to complete the anastomosis is observed in the robot-assisted group (33–16 min). Here, we report the feasibility of robot-assisted supermicrosurgical anastomosis in LVA, indicating promising results for the future of reconstructive supermicrosurgery.

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Advancements in reconstructive microsurgery have evolved into supermicrosurgery; connecting vessels with diameter between 0.3 and 0.8 mm for reconstruction of lymphatic flow and vascularized tissue transplantation
We report on the first-in-human use of the MUSA for robotassisted lymphatico-venous anastomosis (LVA) in patients suffering from breast cancerrelated lymphedema (BCRL)
Robot assistance may potentially overcome the human limitations in challenging supermicrosurgical interventions such as the LVA procedure in BCRL

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Advancements in reconstructive microsurgery have evolved into supermicrosurgery; connecting vessels with diameter between 0.3 and 0.8 mm for reconstruction of lymphatic flow and vascularized tissue transplantation. Robot assistance can help overcome these human limitations, thereby enabling a breakthrough in supermicrosurgery. We report the feasibility of robot-assisted supermicrosurgical anastomosis in LVA, indicating promising results for the future of reconstructive supermicrosurgery. As a result of evolving technology in microscopes and instruments, microsurgeons are able to perform supermicrosurgery by connecting vessels with a diameter a between 0.3 and 0.8 mm for the reconstruction of lymphatic flow and vascularized tissue transplantation. Facilitating supermicrosurgical procedures by robot assistance could overcome these human limitations. A widely used robotic system for many different surgical disciplines is the Da Vinci system (Intuitive Surgical Inc.TM, Sunnyvale, USA) This device was created to perform mainly endoscopic surgery and showed limitations in microsurgical procedures[1,2,3,4,5]. The robot is maneuverable, equipped with arms holding genuine (super) microsurgical instruments that are placed into the holders, and are compatible with conventional surgical microscopes

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