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J Reconstr Microsurg
DOI: 10.1055/a-2659-7126
Original Article

The Clinical Pearls and Pitfalls of Using the Symani System in Microsurgery

Anshul Ratnaparkhi 
1   Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Emily Finkelstein
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Aneeq S. Chaudhry
3   Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
,
Kyle Xu
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Kashyap Tadisina
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Miguel Medina
4   Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, Florida
,
Sara Danker
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Devinder Singh
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Juan Rodolfo Mella-Catinchi
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Abstract

Background

The improved stability and controllability of robotics has the potential to expand the spectrum of reconstructive surgery. Until recently, however, no robot was designed specifically for microsurgery. The present study aims to summarize the clinical pearls and pitfalls of utilizing the Symani Surgical System in microsurgical practice.

Methods

The PubMed Database was queried using the search term “Symani Robot System” from inception until January 2025. Data regarding demographics, study design, technique, and surgical outcomes were extracted from the full text by two independent reviewers.

Results

In the present analysis, 21 publications encompassing the results of 397 patients (range: 1–100) and 642 robotic anastomoses were included. Of the 335 patients included in the studies that reported complication rates, pooled analysis yielded an overall complication rate of 14.03% (n = 47) and a partial or complete flap loss rate of 2.09% (n = 7). Of 642 robotic total anastomoses, only 1.24% (n = 8) required a transition to a manual approach. A total of 19 groups (90.47%) reported high precision of Symani, 15 (71.43%) highlighted improved surgical access to deeper anatomical fields, and 12 (57.15%) reported enhanced microsurgical ergonomics. Regarding limitations, 13 (61.90%) cited the expense of the system, 5 (23.81%) reported a lack of haptic feedback, 5 (23.81%) identified instrument “stickiness” as a factor slowing operations, and 3 (14.29%) highlighted the need for improved grip. The learning curve associated with Symani was discussed in 15 studies (71.43%).

Conclusion

The results of the present literature review demonstrate that the Symani robot offers numerous benefits that will help advance the field of microsurgery. It provides complete tremor elimination, motion scaling, and improved operative ergonomics, leading to patent anastomosis and complication rates comparable to a traditional manual approach. However, more data are needed before widespread clinical implementation to determine whether the increased precision and controllability outweigh the cost and learning curve.

Lay Summary

The present study highlights the use of the Symani Surgical System, a novel robotic system designed specifically for microsurgery. Symani offers increased precision, dexterity, controllability, and numerous benefits that will help advance the field.

Keywords

robotics microsurgery - Symani Surgical System - robotic lymphatic surgery - robotic supermicrosurgery


Publication History

Received: 28 April 2025

Accepted: 24 June 2025

Article published online:
14 August 2025

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