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

TLDR

Supermicrosurgery reconstructs lymphatic flow using vessels 0.3–0.8 mm, but its success is constrained by the limited precision and dexterity of the surgeon’s hands. This study evaluates whether a dedicated microsurgical robot can overcome these human limitations and enable robot‑assisted supermicrosurgery for breast‑cancer‑related lymphedema. A prospective randomized pilot compared robot‑assisted versus manual lymphatico‑venous anastomosis, assessing 1‑ and 3‑month outcomes, operative time, and anastomotic quality. Robot‑assisted LVA shortened operative time from 33 to 16 min and improved patient outcomes at 3 months, demonstrating feasibility and promising future potential.

Abstract

Abstract 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.