The MUSA robot and its applicability in lymphatic surgery

The development of surgical treatment of lymphedema has been a challenging endeavor. Various surgical modalities have been proposed, but the results are often unsatisfactory. The lymphaticovenous anastomosis (LVA) revolutionized by Koshima et al. with the introduction of super microsurgery has gained traction in the treatment of lymphedema and has shown favorable results. However, super microsurgery requires excellent hand-eye coordination, meticulous tissue handling, dexterity, and operative flow, which are subject to multiple factors. Robot-assisted microsurgery (RAMS) has the potential to increase safety for clinicians and patients and create new possibilities in the field of super microsurgery. Therefore, plastic surgeons of the Maastricht University Medical Center (Maastricht, the Netherlands) teamed up with engineers from the Eindhoven University of Technology (Eindhoven, the Netherlands) and developed the first dedicated robotic platform for (super)microsurgery, the MUSA. The development of MUSA, from inception to the first clinical study in patients with lymphedema, has yielded promising results. This review aims to elucidate the development of the MUSA and its role in lymphatic surgery.