Arch Hand Microsurg.  2019 Dec;24(4):358-367. 10.12790/ahm.2019.24.4.358.

Robotic Microsurgery Training for Robot Assisted Reconstructive Surgery

• Hong JW
• Shin D
• Lee DW
• Lee WJ

• KMID: 2464472
• DOI: http://doi.org/10.12790/ahm.2019.24.4.358

Abstract

PURPOSE
Recent advances in robotic surgery have affected not only surgery for visceral organs but also head and neck cancer surgery and microsurgery. The authors intended to analyze and share experience gained from performing microanastomosis training in a new robotic surgery system.
METHODS
Robotic microanastomosis training was performed using Da Vinci Xi. The robot arm used two black diamond forceps, one Potts scissor, and one vision camera. First, basic robotic surgery skills were trained with Da Vinci Skill Simulator training. Actual microanastomosis practice was performed using artificial blood vessel, chicken wing and porcine leg.
RESULTS
Three simulation training sessions were performed and five vessel anastomosis were performed. A total of 8 vascular anastomosis were performed, and anastomosis for one vessel took 31-57 minutes. The number of sutures used was more than one initially due to suture material damage, but one suture was used after four anastomosis. In the anastomosis time analysis with porcine legs, the actual anastomosis process took 2 minutes 15 seconds±41 seconds per stitch. The vascular anastomosis interval took more time than vascular anastomosis itself due to robot arm change and camera movement.
CONCLUSION
Robotic microsurgery training was not difficult process for surgeons who had undergone conventional microsurgery. However, more training was needed to replace the robot arm and move the camera. In the long term, mechanical improvements in diamond forceps and camera resolution were necessary. In order to master robotic microsurgery, surgeons must get used to robotic surgery system through simulation training.

Keyword

Microsurgery; Robotics; Anastomosis; Training

MeSH Terms

Arm
Blood Substitutes
Chickens
Diamond
Head and Neck Neoplasms
Leg
Microsurgery*
Robotics
Simulation Training
Surgeons
Surgical Instruments
Sutures
Blood Substitutes
Diamond

Figure

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  Fig. 1 Robotic microsurgery training model using porcine leg. (A) Da Vinci Xi model composed of one camera vision and three instruments was used. (B) Two black diamond forceps and one Potts scissors were required for robotic microsurgery.

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  Fig. 2 Robot arm and camera set up for robotic microanastomosis. Robot arm 1, 2 are black diamond micro forceps. Diamond forceps serve as the Jeweler forceps, vessel dilator and microneedle holder. Robot arm 3 is a Potts scissor, which acts as a micro metzenbaum and scissor. In robotic microsurgery, the scissor arm should be positioned outside the operation field to prevent collisions between instruments and to facilitate optimal view for surgeons. When performing the cut, arm 2 is replaced with arm 3 and arm 3 is brought into the field. Camera 4 adjusts the magnification by shifting the focal length.

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  Fig. 3 After robotic neck dissection with retroauricular incision, the anastomotic surgical field should be approached laterally. Considering the actual surgery, the robot arm was set at an angle of 45 degrees.

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  Fig. 4 Robotic microsurgery. (A) Vessel preparation and skeletonization were successful with micro robotic instruments. Adventitia layer was partly left for holding. (B) Robotic microanastomosis. Care should be taken not to open suddenly when placing diamond forceps inside the vessel. Also, surgeons should make sure that the suture needle does not hit the instrument and be damaged.

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  Fig. 5 Microanastomosis training material for robotic microsurgery training. (A) Practice model using artificial blood vessels. (B) Practice model using the chicken wing. (C) Practice model using the porcine leg. After robotic microsurgery, authors cut the area around anastomosis and check the internal diameter. (D) Anastomosis was confirmed by complete excision of blood vessels.

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