Preclinical experience using a new robotic system created for microsurgery

Background: Completing microsurgical anastomosis requires great technical skills. Robotic assistance in microsurgery can exceed the maximum human level of precision and manual dexterity to improve clinical outcomes. Since no robotic device has been designed primarily for microsurgery the authors developed a dedicated microsurgical robotic system (MSR). This preclinical study investigates whether microsurgical anastomosis can be successfully completed on silicone vessels using a prototype of this newly developed robotic system, and compares outcomes of robotic-assisted versus conventional anastomotic microsurgery. Methods: Three participants at different levels of microsurgical training completed ten anastomoses by hand and ten anastomoses with robotic assistance. Four blinded experienced microsurgeons evaluated the quality of the microsurgical skills using a modified version of the Structured Assessment of Microsurgical Skills (SAMS). Time to perform the anastomosis and adverse events were recorded. Results: The total time to perform the anastomoses with and without robotic assistance decreased to 35.1 minutes and 12.5 minutes respectively during the study. The overall performance and indicative skill of the SAMS improved during the conventional method (from respectively 2.8 to 3.6 and 2.6 to 3.7) and the robotic-assisted method (from respectively 2.3 to 3.0 and 2.3 to 3.1). Conclusions: It is feasible to complete anastomotic microsurgery on silicone vessels using the MSR. In comparison to the conventional method, time to perform the anastomosis was longer and quality of the microsurgical skills were lower in the robotic-assisted group. However, the robotic-assisted performance showed steeper learning curves (faster improvement) compared to the conventional performance for both surgical time and domains of microsurgical skills. The encouraging results indicate further development of the MSR and additional preclinical trials as step up towards clinical validation. FINANCIAL DISCLOSURE STATEMENT: Tom van Mulken has a financial disclosure, as he is Chief Medical Officer of the spin off company MicroSure: costs of travel and share in company. Rene van der Hulst has a financial disclosure as shareholder of MicroSure. Raimondo Cau has a financial disclosure, as he is Chief Technical Officer and shareholder of MicroSure. Ferry Schoenmakers is a software developer for MicroSure. The other authors have no financial disclosures. ACKNOWLEDGEMENTS: The four microsurgeons, forming the assessment panel, are gratefully acknowledged for their efforts. CORRESPONDING AUTHOR: Tom J.M. van Mulken, MD, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands, Tel: (+31) 043-3875474; Fax: (+31) 043-3875473, Email: tom.van.mulken@mumc.nl ©2018American Society of Plastic Surgeons

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