Roboter-assistierte Mikrochirurgie in der Rekonstruktion der unteren Extremität

Zusammenfassung

Hintergrund In den letzten Jahren wurden verschiedene Robotersysteme entwickelt und zugelassen, welche spezifisch für die Mikrochirurgie konzipiert wurden. Bisher gibt es zu diesen Systemen nur wenig Evidenz. In unserer Studie untersuchen wir den Einsatz robotisch assistierter Mikrochirurgie in der mikrochirurgischen Rekonstruktion der unteren Extremität.

Patienten/Material und Methoden Die Daten wurden prospektiv zwischen Februar und November 2023 erfasst. Das Symani-Robotersystem wurde bei 42 mikrochirurgische Eingriffe an der unteren Extremität verwendet und die Ergebnisse ausgewertet.

Ergebnisse Das Durchschnittsalter der Patienten betrug 57±18 Jahre. Es wurden insgesamt 39 freie Lappenplastiken (95%), ein lymphchirurgischer Eingriff (3%) und zwei Nerventransfers (5%) durchgeführt. Insgesamt wurden 46 Anastomosen und Nervenkoaptationen durchgeführt. Hierbei wurden sechs arterielle End-zu-End-Anastomosen (11%), sieben arterielle End-zu-Seit Anastomosen (13%), 36 venöse End-zu-End-Anastomosen (65%), zwei lymphovenöse Anastomosen (4%) und fünf epineurale Koaptationen im Rahmen von Nerventransfers (9%) durchgeführt. Arterielle End-zu-End-Anastomosen dauerten durchschnittlich 26±12 Minuten und arterielle End-zu-Seit-Anastomosen benötigten 42±21 Minuten. Die venösen Anastomosen dauerten im Durchschnitt 33±12 Minuten. Die Nervenkoaptation benötigten im Mittel 24±13 Minuten. In keinem Eingriff war eine Konversion auf die konventionelle Handnaht notwendig. Es kam zu zwei arteriellen Thrombosen (5%). In einem Fall konnte eine erfolgreiche Revision die Lappenplastik retten. Es gab einen totalen Lappenverlust, jedoch keine partiellen Lappenverluste.

Schlussfolgerung Wir konnten unter Verwendung des Symani-Robotersystems in der mikrochirurgischen Rekonstruktion der unteren Extremität Ergebnisse aufzeigen, welche mit der konventionellen Mikrochirurgie vergleichbar sind.

Abstract

Background In recent years, various robotic systems specifically designed for microsurgical tasks have been developed and approved. There is not much evidence for these systems to date. In our study, we examined the use of robot-assisted microsurgery in the reconstruction of the lower extremity.

Patients/Material and Methods Data was prospectively collected between February and November 2023. The Symani robotic system was used in 42 robot-assisted microsurgical procedures on the lower extremity, and the results were evaluated and documented.

Results The average age of the patients was 57±18 years. A total of 39 free flap reconstructions (95%), one lymphatic surgical procedure (3%) and two nerve transfers (5%) were performed. In total, 46 anastomoses and coaptations were carried out. This included six arterial end-to-end anastomoses (11%), seven arterial end-to-side anastomoses (13%), 36 venous end-to-end anastomoses (65%), two lymphovenous anastomoses (4%), and five epineural coaptations in the context of nerve transfers (9%). Arterial end-to-end anastomoses took an average of 26±12 minutes, and arterial end-to-side anastomoses took 42±21 minutes. The venous anastomoses took an average of 33±12 minutes. Epineural coaptations took an average of 24±13 minutes. In no procedure was there a need for a conversion to conventional hand suturing. There were two arterial thromboses (5%), one of which was successfully revised to save the flap. One total flap loss occurred, but there were no partial flap losses.

Conclusion Using the Symani robotic system for microsurgical reconstruction of the lower extremity, we were able to demonstrate results that are comparable to conventional microsurgery.

Schlüsselwörter

Mikrochirurgie - untere Extremität - Körperregion und Anatomie - freie Lappenplastiken  - Mikrochirurgie - Roboter-assistierte Mikrochirurgie

Keywords

Microsurgery - Lower Extremity Reconstruction - Robot-assisted Microsurgery - Free Flap

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