(A625) Robot-Assisted Microsurgery in Head & Neck Reconstruction: Early Experience at a Single Institution

Introduction: Microvascular robotic systems aim to increase the precision and feasibility of microvascular surgery through Robot-Assisted Microsurgery (RAMS). This study aims to describe the role of RAMS in head & neck microvascular reconstruction.

Methods: All head and neck reconstructive procedures involving microvascular free flap surgery at our institution that were performed using RAMS were included in the study. The Symani System and Mitaka HawkSight exoscope were employed by an experienced microvascular surgeon who had completed the requisite RAMS training and certification. Arterial anastomoses were performed with the Symani System, while venous anastomoses were completed manually using coupler devices, with magnification provided by the exoscope. Key metrics recorded included arterial anastomosis time, ischemia time, arterial anastomosis success rate, and flap survival rate.

Results: To date, twelve head and neck reconstructive surgeries have been completed using RAMS. A total of twelve end-to-end arterial anastomoses were performed. The average arterial anastomosis time was 42 minutes, and average ischemia time was 94 minutes. Of the twelve anastomoses, eleven were successful, while one required a manual revision to reduce ischemia time. One flap experienced postoperative total failure, which necessitated replacement with a pedicled flap.

Conclusions: Our early experience indicates that successful end-to-end arterial anastomoses can be achieved using the Symani System and Mitaka HawkSight exoscope in head and neck reconstruction. However, prolonged arterial anastomosis and ischemia times, along with elevated flap and anastomosis failure rates, suggest a significant learning curve associated with RAMS. Continued use and familiarity with the Symani System will be essential to optimize outcomes and clarify the role of RAMS in microvascular head and neck reconstructive surgery.