Robot-assisted microsurgery in The Netherlands

A team of plastic surgeons from Maastricht UMC + in The Netherlands has successfully carried out super microsurgical procedures with the help of robotic technology.

Claimed to be the first such study in the world, the results — published in Nature Communications — are considered a move towards the adoption of robot-assisted microsurgical procedures.

The collaborative pilot study — involving Maastricht UMC + plastic surgeons and technicians from Eindhoven University of Technology and spin-off company Microsure — tested a robot named ‘MUSA’ during an LVA (lympho-venous anastomosis) procedure to treat lymphoedema in the arms. LVA involves linking lymph vessels to very small blood vessels in order to remove excess lymph fluid and thus requires micro-scale accuracy.

Super microsurgery in general involves operating on the smallest of vessels (with a diameter of 0.3 to 0.8 mm), requiring surgical accuracy that approaches the limits of human capability. The need for minimal hand vibrations means that this type of intervention can only be performed by a few surgeons. That’s where robotics comes in — MUSA can filter out minimal vibrations from a surgeon’s hand.

Lymphedema often occurs after breast cancer treatment if the lymph nodes in the armpit are removed or irradiated. For this reason, many women with lymphedema after breast cancer treatment wear arm stockings for the rest of their lives.

The pilot study investigated the feasibility and safety of LVA surgery with support from MUSA, concluding that it is safe and possible to connect lymphatic vessels of 0.3 to 0.8 mm in diameter to blood vessels using the robot.

The researchers said that large, multi-centre follow-up studies were needed to further investigate the differences between surgery with and without robot support.

Image caption: Tom van Mulken and a colleague working with the robot, MUSA. Image courtesy of Maastricht UMC+.