Conventional and Robot-Assisted Microvascular Anastomosis - Systematic Review

Background: The complexity of plastic microsurgery yields many risks. Robot assistance has been sought to maximize outcome and minimize complications. Reportedly, it offers increased dexterity and flexibility with attenuated human flaws, such as tremors and fatigue. This systematic review will further investigate that claim. Methods: A systematic search was conducted for operative outcomes and operator experience of reconstructive plastic microsurgery compared between conventional and robot-assisted procedures. Data were summarized then meta-analyzed or qualitatively assessed and critically appraised to determine the difference robot assistance offers. Results: This review comprises 4 studies, mainly investigating robot-assisted microvascular anastomosis. Meta-analysis of anastomosis time reveals that robot-assisted takes more time than conventional without offering substantial health-related improvements. However, it offers greater comfort, consistency, and flexibility for operators. Conclusions: Robot assistance lengthens operative times because of its relative lack of implementation and subsequent lack of experienced operators. Times were quick to be improved as repeated procedures were performed and technical complications can be resolved by more experience with robotic equipment. Furthermore, it generally offers better operator experience. Despite this, robot assistance does not offer a better health outcome compared to conventional anastomosis although its benefits may lie in aesthetic outcomes instead. Exploration of that aspect as well as non-summarizable health outcomes are the two primary limitations of this review that warrants further investigation into the subject.