Robot-assisted surgery represents a significant innovation in reconstructive microsurgery, providing enhanced precision and reduced surgeon fatigue. This study examines the integration of robotic assistance in a series of 85 consecutive robot-assisted microsurgical (RAMS) operations. It aims to evaluate changes in the integration of RAMS during the implementation phase in a single institution. The study utilized a prospective database encompassing all robot-assisted microsurgical cases using the Symani surgical system from February until December 2023. A total of 85 robot-assisted operations were analyzed, showing a broad application across various types of reconstructive needs, predominantly in lower extremity repairs ( n = 41). There were 68 free flap reconstructions (80.0%), ten nerve transfers (11.8%), four targeted muscle reinnervations (TMR; 4.7%), two lymphovenous anastomoses (2.4%) and one arterial reconstruction. The adoption of both traditional and digital exoscopic magnification systems was optimized for each surgical context. The operating room setup and infrastructural challenges for the different anatomic regions are presented. The introduction of robot-assisted surgery entailed overcoming challenges such as adapting to the lack of haptic feedback and navigating ergonomic constraints. Despite these hurdles, including higher operational costs and increased surgery durations, the precision and ergonomic benefits offered by robotic systems may be substantial. Potential solutions and tips to improve the operating times include frequent cleaning of the instruments, active surgical assistance, and rigorous presurgical planning of the logistical setup in the operating room. We showed that there is a preference for the utilization of digital exoscopes over conventional microscopes in RAMS, despite requiring more time per stitch when using the exoscope.

Introduction: Mastering microsurgery requires advanced fine motor skills, hand–eye coordination, and precision, making it challenging for novices. Robot-assisted microsurgery offers benefits, such as eliminating physiological tremors and enhancing precision through motion scaling, which may potentially make learning microsurgical skills easier. Materials and Methods: Sixteen medical students without prior microsurgical experience performed 160 anastomoses in a synthetic model. The students were randomly assigned into two cohorts, one starting with the conventional technique (HR group) and one with robotic assistance (RH group) using the Symani surgical system. Results: Both cohorts showed a reduction in procedural time and improvement in SAMS scores over successive attempts, with robotic anastomoses demonstrating a 48.2% decrease in time and a 54.6% increase in SAMS scores. The decreases were significantly larger than the RH group (p < 0.05). The quality of the final anastomoses was comparable in both groups (p > 0.05). Discussion: This study demonstrated a steep preclinical learning curve for robot-assisted microsurgery (RAMS) among novices in a synthetic, preclinical model. No significant differences in SAMS scores between robotic and manual techniques after ten anastomoses. Robot-assisted microsurgery required more time per anastomosis, but the results suggest that experience with RAMS may aid in manual skill acquisition. The study indicates that further exploration into the sequencing of robotic and manual training could be valuable, especially in designing structured microsurgical curricula.