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German researchers perform first hands-free robotic microsurgery

by John R. Fischer, Senior Reporter | August 26, 2022
European News Operating Room
German researchers have performed the first complete robotic microsurgery procedures without a doctor present in the operating room.
Scientists at the University of Münster in Germany have performed the first exclusive robot-supported microsurgical procedure on human beings.

Using the Symani Surgical System, designed for microsurgery, and a robotic microscope, doctors performed five operations, including complex breast reconstruction and tissue transplants, without the surgeon being present at all in the operating area.

Together, both instruments can be used to rejoin fine anatomical structures such as blood vessels, nerves or lymphatic vessels with diameters of only 0.3 millimeters.

“This new method for operations enables us to work with a much higher degree of delicacy and precision than is possible with conventional operating techniques. As a result, less tissue is destroyed and patients recover faster,” said Dr. Maximilian Kückelhaus, of the university’s Centre for Musculoskeletal Medicine, in a statement.

The Symani Surgical System mimics the surgeon’s hand movements through an electromagnetic field and joystick, but reduces them in size by up to 20 times. This eliminates the presence of shaking in human hands.

With the robotic microscope, surgeons can view the area being operated on via a 3D augmented reality headset with two high-resolution monitors and binoculars that combine the real world with virtual information. The surgeon’s head movements are recorded and transferred to the robot, enabling them to view the area from complex angles.

The doctor can also access menus and perform functions through the robot without using their hands, and relax their posture. “This, in turn, protects us from fatigue, and that means that our concentration can be maintained over a period of many hours,” said Tobias Hirsch, chair of plastic surgery at Münster University. “In initial studies involving the systems, before they were used in operations, we were already able to confirm the positive effects on the quality of operations and on ergonomics.”

Training with students and microsurgeons showed improvement over conventional operating techniques. Development and clinical trials were funded by the EU.

Kückelhaus and Hirsch plan to perform more operations for scientific studies on the quality of operations and ergonomics.

“Not having to be at the operating table can also mean that one day the operating surgeon will no longer have to be physically present. An expert might be able to perform special operations at any one of several locations — without having to travel and be there in person,” said Kückelhaus.

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