Will anyone soon be able to operate?
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Foto: OP-Roboter-Pflegekraft-Patient-Hand-OP-copyright-BG Klinik Ludwigshafen/Ute Kühnlein Foto: OP-Roboter-Pflegekraft-Patient-Hand-OP-copyright-BG Klinik Ludwigshafen/Ute Kühnlein

Will anyone soon be able to operate?

"Eliminating human fallibility with robotic microsurgery"

Robot-assisted microsurgical technologies are making surgery ever more precise. These technologies make it possible to treat the smallest structures with great precision. At the same time, they reduce the physical strain on surgeons.

Microsurgeon Dr Arne Hendrik Böcker is Chief Physician in the Department of Hand and Peripheral Nerve Surgery and Rehabilitation and Deputy Clinic Director at the BG Klinikum Ludwigshafen. He operates several times a week with the Symani surgical robot. The mobile device is used for microsurgical procedures on very small nerves and lymphatic vessels. We spoke to Dr Böcker about the possibilities and current limitations of this pioneering technology.

Topics in the article:
  • Skills: What capabilities does the Symani surgical robot have?
  • Ergonomics and optics: How does the exoscope help with a relaxed posture?
  • Disadvantages: What can be improved?
  • The next level: telemedicine and machine learning in microsurgery


Skills: What does the Symani surgical robot do?

Photo: Symani robot chair and foot control with gripper arms; copyright:BG Klinikum Ludwigshafen/Kühnlein

The surgeon explains: "The rule of thumb is: the smaller, the better. Then the advantages of the robot are greatest." Although it does not suture any faster (average time per stitch: 4.5 minutes), it does so without any tremor and with a movement that is twenty times smaller. "And of course this also results in a lower complication rate for the patient."

The study "Technical Strategies and Learning Curve in Robotic-assisted Peripheral Nerve Surgery" examined the use of the Symani robotic system in peripheral nerve surgery, particularly with regard to technical implementation, the surgical procedure and the surgeons' learning curve. The precision of the robotic technology in the treatment of nerve damage and the influence on the efficiency and learning process of the surgeons were analyzed.

Here are some of the results of the study at a glance:

Graphic: operating hands with tools and magnified view of the tool tips - Font: no tremor and 20:1 motion reduction
nerve coaptations are possible in a single operation.
mm diameter: the smallest blood vessels can be sutured.
hours of training are usually sufficient for surgeons.

This is the workflow with the Symani:

Ergonomics and optics: How does the exoscope help with a relaxed posture?

The Symani system can either be combined with a microscope in the conventional way or with an exoscope. Dr. Böcker explains the advantages from an ergonomic and optical point of view:
(Click "cc" for the English subtitles!)

Disadvantages: What can be improved?

Despite the many advantages, there is still room for improvement with the Symani robot. One of the biggest areas of improvement is its suitability for larger vessels and nerves. The Symani is particularly effective for very small, delicate structures such as nerves, lymphatic vessels and small arteries, where high precision is required. However, the robot currently offers fewer advantages for larger vessels or nerves. For larger interventions, Dr. Böcker then resorts to the conventional surgical method.

He doesn't regard the fact that a pioneering technology such as the Symani still needs to be developed further as no negative, but emphasizes that every technology must always be advanced in cooperation between industry and medicine.

Photo: Gripping tools of the Smaynis with covers; copyright: BG Klinikum Ludwigshafen/Kühnlein

Sustainability

The handle tools are currently disposable items, so a lot of waste is produced.

Handle strength

Limited grip strength of the instruments makes it difficult to work with heavily scarred tissue or thick nerves.

Blood clot formation

Instruments can be contaminated by blood clots, which requires additional cleaning steps.

Costs

A Symani system costs several hundred thousand euros, with additional running costs for consumables and maintenance. High investment and operating costs limit the availability of the technology.

Technical requirements

Extra space is needed and the installation in the operating room is complex.

The next level: Telemedicine and machine learning in microsurgery

A decisive step for the future of the Symani robot could be the integration of telemedicine. It could make it possible to perform operations remotely, which could play an important role, especially in remote areas or when supporting specialists. Of course, telemedicine could also simply be used to directly consult an expert for certain procedures.

"In the long term, I believe more in the machine learning component," says Böcker, explaining his vision in the video statement:

(Click "cc" for the English subtitles!)

The Symani robot offers precise, tremor-free microsurgery, which is particularly advantageous when treating small nerves and vessels. By scaling the movements and decoupling the surgeon from physical strain, it improves both accuracy and ergonomics. Future developments such as machine learning and telemedicine could further expand the potential of the technology, making surgery more efficient and accessible.

How much autonomous working will be possible in the future? Will ethical, emotional or technological aspects prevent us from getting to the point where everyone will soon be able to operate? At the very least, Dr. Böcker is certain that “with robotic microsurgery, we can eliminate human fallibility” and raise the quality of operations to a whole new level.

Interview and multimedia realization: Natascha Mörs

MEDICA-tradefair.com

 

 

Bild: Medizinstudentin mit VR-Brille und Controllern; Copyright: UKW/Threedee

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