Robotisch-assistierte Lymphchirurgie

Zusammenfassung

In den letzten Jahren finden speziell für die Mikrochirurgie entwickelte Roboter insbesondere in der rekonstruktiven Lymphchirurgie zunehmend Anwendung. Derzeit gibt es zwei Robotersysteme, welche in der Mikrochirurgie eingesetzt werden. Beide Systeme verfügen über Technologien zur Tremorreduzierung und Bewegungsskalierung, wodurch die Präzision und Geschicklichkeit des Chirurgen optimiert werden sollen. In der Klinik für Plastische Chirurgie und Handchirurgie des Universitätsspitals Zürich wird das Symani Surgical System bei vielen mikro- und supermikrochirurgischen Operationen eingesetzt. Das Hauptanwendungsgebiet des Robotersystems liegt in der rekonstruktiven Lymphchirurgie, im Speziellen robotisch-assistierte lymphovenöse Anastomosen, der mikrochirurgische Anschluss des Lymphgewebslappens sowie der Anwendung in der zentralen Lymphchirurgie. Hierbei ermöglicht die Verwendung des Roboters kleinere Operationszugänge für anatomisch tiefe Strukturen und eine Verbesserung der chirurgischen Präzision. In Kombination mit einem Exoskop kann es zudem die Ergonomie des Mikrochirurgen verbessern.

Abstract

Surgical robotic systems specifically developed for microsurgery are increasingly being used in recent years, particularly in reconstructive lymphatic surgery. Currently, there are two robotic systems that are used in microsurgery. Both systems feature tremor reduction and motion scaling technologies, which are intended to optimise the surgeon’s precision and dexterity. In the Department of Plastic Surgery and Hand Surgery at the University Hospital Zurich, the Symani Surgical System is used in many microsurgical and supermicrosurgical procedures. It is mainly used in reconstructive lymphatic surgery, especially for robotic-assisted lymphovenous anastomosis, microvascular anastomosis of lymph node flaps, and it is used in central lymphatic surgery. The robot enables smaller surgical approaches for deep anatomical structures with enhanced surgical precision. In combination with an exoscope, it can also improve the ergonomics of the microsurgeon.

Schlüsselwörter

Robotisch-assistierte Mikrochirurgie - rekonstruktive Lymphchirurgie - Robotisch-assistierte Lymphchirurgie

Keywords

Robotic-assisted microsurgery - Reconstructive lymphatic surgery - Symani Surgical System - Robotic-assisted lymphatic surgery

• Literatur

• 1 van der Hulst R, Sawor J, Bouvy N. Microvascular anastomosis: is there a role for robotic surgery?. J Plast Reconstr Aesthet Surg 2007; 60: 101-102
• 2 Dobbs TD, Cundy O, Samarendra H. et al. A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery-From Inception to the Future. Front Surg 2017; 4: 66
• 3 Lindenblatt N, Grunherz L, Wang A. et al. Early Experience Using a New Robotic Microsurgical System for Lymphatic Surgery. Plast Reconstr Surg Glob Open 2022; 10: e4013
• 4 Selber JC. The Robotic DIEP Flap. Plast Reconstr Surg 2020; 145: 340-343
• 5 Aitzetmuller MM, Klietz ML, Dermietzel AF. et al. Robotic-Assisted Microsurgery and Its Future in Plastic Surgery. J Clin Med 2022; 11: 3378
• 6 van Mulken TJM, Boymans C, Schols RM. et al. Preclinical Experience Using a New Robotic System Created for Microsurgery. Plast Reconstr Surg 2018; 142: 1367-1376
• 7 van Mulken TJM, Schols RM, Scharmga AMJ. et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial. Nat Commun 2020; 11: 757
• 8 van Mulken TJM, Schols RM, Qiu SS. et al. Robotic (super) microsurgery: Feasibility of a new master-slave platform in an in vivo animal model and future directions. J Surg Oncol 2018; 118: 826-831
• 9 Grunherz L, Gousopoulos E, Barbon C. et al. [Robotics in plastic surgery]. Chirurgie (Heidelb) 2023; 94: 325-329
• 10 Ballestin A, Malzone G, Menichini G. et al. New Robotic System with Wristed Microinstruments Allows Precise Reconstructive Microsurgery: Preclinical Study. Ann Surg Oncol 2022; 29: 7859-7867
• 11 Barbon C, Grünherz L, Uyulmaz S. et al. Exploring the learning curve of a new robotic microsurgical system for microsurgery. JPRAS Open. 2022
• 12 van Mulken TJM, Wolfs J, Qiu SS. et al. One-Year Outcomes of the First Human Trial on Robot-Assisted Lymphaticovenous Anastomosis for Breast Cancer-Related Lymphedema. Plast Reconstr Surg 2022; 149: 151-161
• 13 Gousopoulos E, Grünherz L, Giovanoli P. et al. Robotic-assisted microsurgery for lymphedema treatment Plast Aesthet Res 2023; 10: 07
• 14 Weinzierl A, Barbon C, Gousopoulos E. et al. Benefits of robotic-assisted lymphatic microsurgery in deep anatomical planes. JPRAS Open 2023; 37: 145-154
• 15 Grünherz L, Weinzierl A, Puippe G. et al. First-in-human use of a microsurgical robotic system for central lymphatic reconstruction. accepted for publication in Plast Reconstr Surg Glob Open. 2023
• 16 Trenor CC, Chaudry G. Complex lymphatic anomalies. Semin Pediatr Surg 2014; 23: 186-190
• 17 Lindenblatt N, Gutschow CA, Vetter D. et al. Lympho-venous anastomosis for the treatment of congenital and acquired lesions of the central lymphatic system: a multidisciplinary treatment approach. European Journal of Plastic Surgery 2021; 45 (2)
• 18 Lindenblatt N, Puippe G, Broglie MA. et al. Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion: A Case Report and Systematic Review of Literature. Ann Plast Surg 2020; 84: 402-408
• 19 Grünherz L, Lindenblatt N. Central lymphatic surgery. Plastic and Aesthetic. Research. 2023; 10: 20
• 20 Beier JP, Hackenberg S, Boos AM. et al. First Series of Free Flap Reconstruction Using a Dedicated Robotic System in a Multidisciplinary Microsurgical Center. Plast Reconstr Surg Glob Open 2023; 11: e5240