Master-slave “robotic” systems have been implemented in various surgical fields, although very few are able to perform microsurgical tasks, and, if so, only for very specialized purposes. From February 2023 we have performed microvascular anastomosis for vascularized free tissue transfer in n=9 patients with extensive (>T2) malignancies in the oral cavity and the oropharynx and hypopharynx. The Symani Surgical master-slave robotic system (MMI Inc., Pisa, Italy) consists of a set of two disposable microsurgical manipulators that are attached to the arms of the motorized “slave” unit. Radial forearm flaps were used in all cases for reconstruction of the tumor defect. Arterial micro anastomosis was performed successfully in all cases end-to-end with either the facial or superior thyroid artery as donor vessel. 2 cases required revision of arterial anastomosis due to early failure of blood flow. Duration of ischemia for the radial forearm flap was kept under 2 hours in all but one case, before arterial perfusion was re-established. The microsurgical master-slave system was successfully used to perform micro vascular surgery unde specific conditions of mucosa defect reconstruction.
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