The first total robotic-assisted lymphovenous anastomosis: prospects for innovation and future development.

PURPOSE: Lymphovenous anastomosis is a well-established treatment method for peripheral lymphedema. To date, microsurgical robotic platforms have been used exclusively for the anastomosis of vessels in lymphatic surgery. This study reports on the first total robotic-assisted lymphovenous anastomosis and further highlights future directions for microsurgical robotic assistance in lymphatic surgery.

METHODS

Using the Symani® Surgical System, two patients with lower extremity lymphedema received total robotic-assisted lymphovenous anastomoses. This included robotic-assisted microdissection of lymphatic and venous vessels followed by performance of a robotic-assisted lymphovenous anastomosis.

RESULTS

A total of four complete robotic-assisted lymphovenous anastomoses were performed in the lower legs of two patients. All anastomoses showed patency in the intraoperative indocyanine green imaging, demonstrating the feasibility of total robotic-assisted lymphovenous anastomosis.

CONCLUSION

Total robotic-assisted lymphovenous anastomosis is a safe and feasible surgical technique. Microsurgical robotic assistance enhances the surgeon's precision and improves the ergonomics, thus ameliorating surgical endurance. Further studies are required to compare this new technique to a traditional manual approach regarding the surgical outcome and cost efficiency. Future technical refinements such as a greater variety of microsurgical instruments and the possibility of automated robotic surgery could further expand the application of robotic assistance in lymphatic surgery.