The use of robotics in plastic and reconstructive surgery: A systematic review

Abstract Introduction This systematic review aims to study the feasibility, procedural, approaches, outcomes and complications of robot-assisted plastic and reconstructive surgery in patients and models. Method A systematic review was performed. Medline, Web of Science, Scopus, and Cochrane Library databases were searched. Articles investigating usage of surgeon-controlled robotic technology during plastic and reconstructive surgeries without manual intervention were eligible. Results Forty-one articles were included: 15 case series and 13 case reports, 8 cohort studies, 3 reviews and two surveys. Cohort size was 482, including: 426 patients (mean age: 54.9 years), 27 cadavers, 6 animal models, and 23 survey participants. All studies used the Da Vinci surgical system. The commonest procedure was transoral tumour resection. The commonest indication for reconstruction was head and neck squamous cell carcinoma (56%). The most frequently used flap was local musculo-mucosal (45%). Seventy-nine complications were reported. Conclusions Robot-assisted plastic and reconstructive surgery provides clinical outcomes comparable to conventional techniques. Advantages include reported improved cosmesis, functional outcomes and greater surgeon comfort. Disadvantages included longer operating and set-up times, a learning curve, breaking of microneedles, high monetary costs and authors consistently recommended improved end-effectors. All authors were optimistic about the use of robotics in plastic and reconstructive surgery.