Plastic and reconstructive robotic surgery: 5 cases and a systematic review
Epublication WebSurg.com, Feb 2014;14(02). URL: http://websurg.com/doi/lt03ensaleh001
Introduction We sought to determine the feasibility of robotic microvascular surgery in reconstructive surgery. Additionally, we performed a systematic review to assess the current developments in robotic plastic surgery. Methods Between February 2009 and June 2010, five patients underwent robotic microvascular anastomoses for delayed, free-tissue breast reconstruction, using the deep inferior epigastric artery (DIEP) flap. A PubMed and MEDLINE search was also performed using specific search terms. Results Mean patient age was 55.4 years. Mean robotic anastomotic time was 96 minutes. There were no additional errors of management (EOM). Figure 1 shows anastomotic times. No intraoperative or postoperative flap-related complications were encountered. The literature search yielded 338 articles. Only 19 publications were relevant and further analyzed. The majority of authors report outcomes of microvascular surgery in laboratory conditions. Robotic microsurgery is accurate but consistently takes longer than with the microscope. Investigators consistently report poor haptic feedback. Conclusion Robotic microsurgery is safe in our experience. The current literature illustrates comparable vascular patency rates at the cost of longer operative times. Comparing robotic and standard microsurgery may be hampering the evolution of robotic plastic surgery because of this focus. The ability to perform microsurgery in confined anatomical spaces will reduce patient morbidity and potentially reduce in-patient stay. The ability to raise and inset flaps and explore neural and vascular structures, whilst avoiding large access wounds at both donor and recipient sites, is very attractive. Consequently, we believe that there any many reconstructive applications, and collaboration to produce meaningful clinical outcomes is required.