D41. Preclinical Performance Of The Combined Application Of Two Robotic Systems In Microsurgery - A Two-center Study

PURPOSE: Recent advancements in the development of robotic devices increasingly draw the attention towards the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial. METHODS: Six novices, residents and experienced microsurgeons (n=18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the ALI score, microsurgical skills using the SAMS score and surgical ergonomics using the REBA score. RESULTS: All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, while satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with less microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared to conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants. CONCLUSION: The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. In addition, combined surgical and visual robotic systems could leverage remote microsurgery in the future. This two-center trial provides promising evidence for a steep learning curve upon introduction of those systems, suggesting to further pursue their clinical integration.