Robotic-assisted lymphatic surgery for lymphedema: Bibliometric mapping of an emerging reconstructive field.

BACKGROUND

Lymphatic reconstruction, including lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), is an established surgical treatment for chronic lymphedema. However, these procedures rely on supermicrosurgical manipulation of submillimeter vessels, rendering outcomes highly dependent on surgeon dexterity and technical precision. Robotic platforms have recently been introduced to enhance stability and tremor filtration. However, the evidence and true patient benefit of the existing literature remain subject of ongoing debate.

METHODS

A bibliometric analysis of the Web of Science Core Collection was conducted to identify publications on robotic-assisted lymphatic reconstruction from database inception to February 2026. Eligible records were manually screened. Publication trends, levels of evidence, citation metrics, geographic distribution, and collaborative networks were analyzed using VOSviewer.

RESULTS

Thirty-five studies met the inclusion criteria. Publication activity became more consistent from 2023 onward, accounting for 71.4% of all articles. The evidence base was dominated by low-quality studies, with level V research comprising 68.6% of publications. Notably, research output was concentrated within a limited number of high-volume centers, primarily located in the United States and Switzerland, with little international collaboration.

CONCLUSIONS

Robotic-assisted lymphatic surgery for lymphedema is a rapidly emerging field characterized by increasing publication activity, but limited quality of evidence. Current studies support technical feasibility in selected settings, but remain insufficient to establish clinical superiority or cost-effectiveness compared with manual surgery. The field is currently driven by technological innovation rather than high-level clinical validation. Prospective comparative studies are required to define the role of robotic platforms in physiological lymphatic reconstruction.