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Gousopoulos et al. Plast Aesthet Res 2023;10:7 Plastic and
DOI: 10.20517/2347-9264.2022.101
Aesthetic Research

Review Open Access

Robotic-assisted microsurgery for lymphedema
treatment

Epameinondas Gousopoulos, Lisanne Grünherz, Pietro Giovanoli, Nicole Lindenblatt

Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich CH-8091, Switzerland.
Correspondence to: Prof. Nicole Lindenblatt, Department of Plastic Surgery and Hand Surgery, University Hospital Zurich,
Raemistrasse 100, Zurich CH-8091, Switzerland. E-mail: nicole.lindenblatt@usz.ch

How to cite this article: Gousopoulos E, Grünherz L, Giovanoli P, Lindenblatt N. Robotic-assisted microsurgery for lymphedema
treatment. Plast Aesthet Res 2023;10:7. https://dx.doi.org/10.20517/2347-9264.2022.101
Received: 1 Sep 2022 First Decision: 13 Dec 2022 Revised: 12 Jan 2023 Accepted: 10 Feb 2023 Published: 21 Feb 2023

Academic Editor: Hiroo Suami Copy Editor: Ying Han Production Editor: Ying Han

Abstract
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to
support some of the most demanding microsurgical procedures, which are applied in lymphatic reconstructive
surgery to restore lymphatic vascular integrity and treat lymphedema. Procedures such as the establishment of
lymphovenous anastomosis (LVA), the harvest of lymph nodes from anatomic locations that reduce donor-side
morbidity and the transplantation of the vascularized lymph node flaps (VLNT) present procedures necessitating
extreme precision and dexterity in often difficult-to-reach areas, thus pushing the physical limitations of the
performing microsurgeon. Despite being limited in number, recent preclinical and clinical studies of independent
groups using different robotic systems demonstrate the feasibility of robotic technology to perform
supermicrosurgical procedures successfully. The robotic assistance offers unparalleled precision, refining the
surgical techniques and minimizing potential side effects, with clinical outcomes comparable to the conventional
techniques. Although the relative disadvantages of robotic assistance mostly appear to be related to adequate
training and the prolonged learning curve, the technology promises to revolutionize the field of supermicrosurgery
and improve the clinical outcomes of lymphatic reconstructive surgery.

Keywords: Robotic microsurgery, robotic supermicrosurgery, lymphatic reconstruction, lymphatic surgery,
lymphedema, lymphovenous, vascularized lymph node transfer, robotic-assisted surgery

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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