Clinical, Preclinical, and Educational Applications of Robotic-Assisted Flap Reconstruction and Microsurgery: A Systematic Review

IF 1.5 3区 医学 Q3 SURGERY Microsurgery Pub Date : 2024-10-21 DOI:10.1002/micr.31246
Laura Awad, Edward Bollen, Benedict Reed, Benjamin J. Langridge, Sara Jasionowska, Dariush Nikkhah, Peter E. M. Butler, Allan Ponniah
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Abstract

Introduction

Microsurgery and super-microsurgery allow for highly technical reconstructive surgeries to be performed, with repairs of anatomical areas of less than 1 mm. Robotic-assisted surgery might allow for further advances within microsurgery, providing higher precision, accuracy, and scope to operate in previously inaccessible anatomical areas. However, robotics is not well-established within this field.

We provide a summary of the clinical and preclinical uses of robotics within flap reconstruction and microsurgery, educational models, and the barriers to widespread implementation.

Methods

A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted of PubMed, Medline, and Embase. Preclinical, educational, and clinical articles were included.

Results

One thousand five hundred and forty-two articles were screened; 87 articles met the inclusion criteria across flap harvest, flap/vessel pedicle dissection, vascular anastomosis, and nerve repair. The literature presents several potential benefits to the surgeon and patient such as high cosmetic satisfaction, minimally invasive access with reduced scarring (flap harvest), and low complication rates. Lack of haptic feedback was reported by authors to not impede the ability to perform vessel anastomosis; however, this required further investigation. A steep learning curve was identified, particularly for microsurgeons embarking upon robotic-assisted surgery.

Conclusion

Robotic-assisted surgery can potentially enhance microsurgery and flap reconstruction, with feasibility demonstrated within this review, up to anastomosis of 0.4 mm in diameter. However, there is a lack of sufficiently powered comparative studies, required to strengthen this statement. To increase accessibility to robotic surgery for plastic and reconstructive surgeons, educational opportunities must be developed with standardized assessment of skill acquisition.

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机器人辅助皮瓣重建和显微外科的临床、临床前和教育应用:系统回顾
导言:显微外科和超级显微外科可进行高技术的重建手术,修复小于 1 毫米的解剖区域。机器人辅助手术可能会进一步推动显微外科的发展,提供更高的精度、准确性和范围,在以前无法进入的解剖区域进行手术。然而,机器人技术在这一领域的应用还不成熟。我们总结了机器人技术在皮瓣重建和显微外科中的临床和临床前应用、教育模式以及广泛应用的障碍:方法:根据《系统综述和元分析首选报告项目》对 PubMed、Medline 和 Embase 进行了系统综述。包括临床前、教育和临床文章:结果:共筛选出 1542 篇文章,其中 87 篇文章符合皮瓣采集、皮瓣/血管蒂解剖、血管吻合和神经修复的纳入标准。这些文献为外科医生和患者提供了一些潜在的益处,如较高的美容满意度、减少疤痕的微创入路(皮瓣采集)和较低的并发症发生率。据作者报告,缺乏触觉反馈并不妨碍进行血管吻合术;不过,这还需要进一步调查。结论:机器人辅助手术可以提高外科手术的成功率:机器人辅助手术有可能提高显微外科和皮瓣重建的水平,本综述证明了其可行性,最多可吻合直径 0.4 毫米的血管。然而,目前还缺乏足够支持的比较研究,因此需要加强这一声明。为了让更多整形和重建外科医生能够使用机器人手术,必须提供教育机会,并对技能掌握情况进行标准化评估。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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