Robotics in Microsurgery and Supermicrosurgery

• Published in: Seminars in plastic surgery Vol. 37; no. 3; pp. 206 - 216
• Main Authors: Burns, Heather R, McLennan, Alexandra, Xue, Erica Y, Yu, Jessie Z, Selber, Jesse C
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: robotic microsurgery; supermicrosurgery; robotic plastic surgery; robotic breast reconstruction
• DOI: 10.1055/s-0043-1771506
• ISSN: 1535-2188

Microsurgery has changed the ability to perform highly precise and technical surgeries through the utilization of high-powered microscopes and specialized instruments to manipulate and repair anatomical structures as small as a few millimeters. Since the first human trials of robotic-assisted microsurgery in 2006, the expansion of microsurgery to supermicrosurgery (luminal diameter less than 1 mm) has enabled successful repair of previously inaccessible structures. Surgical robotic systems can offer two distinct operative advantages: (1) minimal access surgery-by entering body cavities through ports, flap harvest can be redesigned to affect a minimally invasive approach for flaps such as the rectus abdominis muscle, the latissimus flap, and the deep inferior epigastric perforator flap; and (2) precision-by eliminating physiologic tremor, improving ergonomics, increasing accessibility to difficult spaces, and providing motion scaling, precision is significantly enhanced. Robotic-assisted microsurgery is a promising application of robotics for the plastic surgeon and has played an important role in flap harvest, head and neck reconstruction, nerve reconstruction, gender-affirming surgery, and lymphatic reconstruction-all the while minimizing surgical morbidity. This article aims to review the history, technology, and application of microsurgery and supermicrosurgery in plastic surgery.