First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial

Tom J M van Mulken, Rutger M Schols*, Andrea M J Scharmga, Bjorn Winkens, Raimondo Cau, Ferry B F Schoenmakers, Shan S Qiu, René R W J van der Hulst, MicroSurgical Robot Research Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

28 Citations (Web of Science)


Advancements in reconstructive microsurgery have evolved into supermicrosurgery; connecting vessels with diameter between 0.3 and 0.8 mm for reconstruction of lymphatic flow and vascularized tissue transplantation. Supermicrosurgery is limited by the precision and dexterity of the surgeon's hands. Robot assistance can help overcome these human limitations, thereby enabling a breakthrough in supermicrosurgery. We report the first-in-human study of robot-assisted supermicrosurgery using a dedicated microsurgical robotic platform. A prospective randomized pilot study is conducted comparing robot-assisted and manual supermicrosurgical lymphatico-venous anastomosis (LVA) in treating breast cancer-related lymphedema. We evaluate patient outcome at 1 and 3 months post surgery, duration of the surgery, and quality of the anastomosis. At 3 months, patient outcome improves. Furthermore, a steep decline in duration of time required to complete the anastomosis is observed in the robot-assisted group (33-16 min). Here, we report the feasibility of robot-assisted supermicrosurgical anastomosis in LVA, indicating promising results for the future of reconstructive supermicrosurgery.

Original languageEnglish
Article number757
Number of pages7
JournalNature Communications
Issue number1
Publication statusPublished - 11 Feb 2020


  • Aged
  • Anastomosis, Surgical/methods
  • Breast Neoplasms/surgery
  • Female
  • Humans
  • Lymphedema/complications
  • Microsurgery/methods
  • Middle Aged
  • Netherlands
  • Pilot Projects
  • Prospective Studies
  • Reconstructive Surgical Procedures
  • Robotic Surgical Procedures/instrumentation

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