Robotic microsurgery: small vessel anastomosis
Epublication WebSurg.com, Jul 2014;14(07). URL: http://websurg.com/doi/lt03enselber001
In 1902, Alexis Carrel developed the technique of end-to-end anastomosis of blood vessels. In 1960, Jules Jacobson described the use of the operating microscope for microvascular surgery. In the late 60’s, Harry Buncke developed the first micro-instruments, and small needles were swaged. Since then, very little has changed about microsurgery, in spite of increasing technical demands, including supermicrosurgery, perforator to perforator anastomosis and lymphatic anastomosis. The surgical robot affords super human levels of precision with high-fidelity, 3-dimensional magnification. This combination of attributes makes it exceedingly well suited for microsurgery. Robotic microsurgery combines the executive functions of the human mind with the precision of a machine. Specific advantages of the robotic platform for microsurgery include: 1) Superhuman precision - this comes in the form of 100% tremor elimination, and up to 5 to 1 motion scaling 2) Physician comfort – the ergonomics of microsurgery can be a challenge and the robot eliminates any physical discomfort or long-term sequel related to surgeon positioning 3) Reduction of physical constraint requirements – access to vessels can be a challenge and the ability to successfully perform an anastomosis requires wide exposure. The robot eliminates this need with long, thin, precise arms. Specific disadvantages include: 1) Lack of haptic feedback, 2) inferior optics as compared to the operating microscope and 3) instrumentation which is ill-suited to microsurgery. It is worth noting that all the advantages to robotic microsurgery are inherent to the field, while all of the disadvantages are platform-specific, and likely to be overcome in the near future.