Free flap breast reconstruction using a novel robotic microscope

Abstract

Introduction: Robotic-assisted surgery (RAS) has evolved over the past decades. Currently, novel robotic systems for microsurgery are being launched onto the European market. This novel microscope (RoboticScope®, BHS, Innsbruck, Austria) is a high-definition camera system, connected to an augmented reality headset, projecting a clear image with high magnification in front of the surgeon's eyes. Motion tracking translates the surgeon's head movements onto the system via a multi-axis robotic arm. We report the first use of the robotic microscope for autologous breast reconstruction in humans.

Methods: In May 2020, ten autologous breast reconstructions were performed by our Team. Five reconstructions (three PAP flaps, one bilateral DIEP flap) were conducted with the robotic microscope and matched to five reconstructions using a conventional microscope. We compared ischaemia times, times for arterial and venous anastomosis, and complications.

Results: All procedures were performed successfully and safely. Overall time for anastomosis was 31 min (+/- 7 min) in the robotic group and 25 min (+/- 7 min, p = 0.30) in the control group. Flap ischaemia was 54 min (+/- 8 min) in the robotic group and 52 min (+/- 22 min, p = 0.87) in the control group. No intraoperative complications such as venous thrombosis or arterial embolism occurred.

Conclusion: Robotic microscopes provide the technology to combine flexibility to choose different angles during pedicle preparation and improve the stationary procedure of vessel anastomosis. Novel robotic systems tailored towards refinement in microsurgery hold great potential for implementation in Plastic Surgery procedures.

Keywords: Breast reconstruction; Microsurgery; Plastic and reconstructive surgery; Robotic surgery.