First completely robot-supported microsurgical operations performed

The first fully robot-supported microsurgical procedures on humans were performed by a team led by researchers Dr. Maximilian Kückelhaus and Prof. Tobias Hirsch from the Centre for Musculoskeletal Medicine at the University of Münster. This is a significant achievement for robotic microsurgery not just in Münster but globally in terms of medicine and science. The doctors employed a novel operating technique in which a robotic microscope is networked with a new type of operations robot created specifically for microsurgery. With this method, it is feasible to remove the operating surgeon entirely from the operating room. In conjunction with Münster University Hospital and Hornheide Specialist Clinic, robotic clinical research is carried out.


This technique has been employed by the professionals for around two months. Five procedures have been completed successfully thus far, and many more are planned. Maximilian Kückelhaus states, “This new approach to operations enables us to operate with a far higher degree of delicacy and accuracy than is achievable with traditional operating approaches.” Less tissue is harmed as a result, and patients recover more quickly. The procedure is used by the experts, for instance, on patients with breast cancer who require intricate breast reconstructions or on patients who need tissue transplants following accidents. Microsurgeons can, for instance, reattach the smallest anatomical structures, such as blood arteries, nerves, or lymphatic vessels, which frequently have a diameter of only 0.3 millimeters, with the help of the robot and the robotic microscope.

The so-called Symani Surgical System, a robot, mimics human hand movements during surgery using an electromagnetic field and joysticks. The small tools used by the robot to perform the operating surgeon’s motions have been shrunk by up to 20 times. This fully removes any hand trembling that could have existed. The operation robot is attached to a robotic microscope, and this microscope displays the region being worked on on two high-resolution monitors using a so-called 3D augmented reality headset. This headgear has a pair of binoculars that can mix real-world and virtual data. Through the recording and transmission of the surgeon’s head motions to the robot, even complex viewing angles of the surgical site are made feasible. The operating surgeon may also use the robot to access a number of menus and carry out tasks without having to use their hands.

The new technology also has the benefit of allowing operating surgeons to take a relaxing stance, as opposed to the difficult posture they would otherwise need to maintain for several hours during operations. According to Tobias Hirsch, who holds the Chair of Plastic Surgery at Münster University, “we have considerably better ergonomics since we can now operate on patients in a remote manner. “This prevents us from being tired, which enables us to retain our focus for several hours at a time. We were able to validate the good impacts on the quality of operations and on ergonomics in early tests using the technologies, before they were employed in operations. The doctors were able to show that, when utilizing the robotic system, the learning curve, the handling of the instruments, and the ergonomics all indicated an improvement over conventional operating approaches during training with students and experienced microsurgeons.

Maximilian Kückelhaus and Tobias Hirsch will carry out further procedures over the following weeks and months, gathering data that they will then analyze in research projects. The quality of operations and ergonomics are in particular significant challenges that need to be addressed. “With this new technology, we aim to be able to not only carry out procedures with a higher level of accuracy and safety, but also, in the case of the smallest structures, to go beyond limitations set by the human body. It’s possible that one day the operating surgeon won’t need to be present in person since they won’t need to be at the operating table. Maximilian Kückelhaus predicts the future: “A specialist could be able to carry out particular operations at any one of numerous places – without having to travel and be there in person.
Funding
Maximilian Kückelhaus received funds from the European Union’s “Recovery Assistance for Cohesion and the Territories of Europe” program for the creation and clinical testing of this novel therapy approach.

Contact the professionals
Maximilian Kückelhaus, M.D.


Head of Experimental Plastic Surgery at the University of Münster’s Center for Musculoskeletal Medicine
Senior Executive Physician, Hand Surgery, Plastic, Reconstructive, and Aesthetic Surgery (Hornheide Specialist Clinic)
Senior surgeon working in the trauma, hand, and reconstructive surgery clinic at the Münster University Hospital
Maximilian Kueckelhaus may be reached at ukmuenster@de
Tobias Hirsch, professor
University of Münster Chair of Plastic and Reconstructive Surgery
Head of the Plastic Surgery Department of the Hornheide Specialist Clinic and Münster University Hospital
Head surgeon of the Hand Surgery and Plastic, Reconstructive, and Aesthetic Surgery departments (Hornheide Specialist Clinic)

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