Robotics in plastic and reconstructive surgery: use of a telemanipulator slave robot to perform microvascular anastomoses.

Many methods for microvascular anastomoses exist, including use of magnifying loupes (x 2.5, x 3.5, x 4.5, x 6), but the operating microscope remains the gold standard. The authors present the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) as an alternative method for performing microvascular anastomoses. The da Vinci robot has fully articulating microinstruments with six degrees of freedom, the ability to filter tremor, the capability to perform telesurgery, and the advantage of 3-D visualization. It offers full and dynamic control over the operating camera, allowing variable positioning and the ability to scale down movements. Its drawbacks include initial high cost, lack of haptic feedback, decreased participation of the first assistant, and lack of widespread availability. In this feasibility study, multiple microanastomoses were performed in canine tarsal and superficial femoral vessels.