Robotics in Plastic and Reconstructive Surgery

162 Pages·2021·7.165 MB·English

by  Jesse C. Selber (editor)

Robotics in Plastic
and Reconstructive
Surgery
Jesse C. Selber
Editor
123
Robotics in Plastic and Reconstructive
Surgery
Jesse C. Selber
Editor
Robotics in Plastic
and Reconstructive
Surgery
Editor
Jesse C. Selber
Department of Plastic Surgery
M.D. Anderson Cancer Center
Houston, TX
USA
ISBN 978-3-030-74243-0 ISBN 978-3-030-74244-7 (eBook)
https://doi.org/10.1007/978-3-030-74244-7
© Springer Nature Switzerland AG 2021
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This book is dedicated to the pioneering men
and women of RAMSES (Robotic Assisted
Microsurgery and Endoscopy Society),
advancing the cause of robotic
reconstruction since 2009.

Preface
It has been my privilege to write and edit this book on robotic plastic and recon-
structive surgery. We are in a time of great change. A global pandemic has required
us to work differently, more remotely, and think in innovative ways about how we
approach traditional problems. Surgical robotics removes the surgeon from much of
the direct contact with the patient, and it is a fitting time to release a book which
highlights these techniques as they apply to reconstructive surgery.
Originally, robotic surgical research was funded by NASA and the military to
facilitate remote operations in forward areas and near-space, where surgical sub-
specialists are in short supply. It turned out that these remote applications were not
immediately practical, and the technology was licensed to Intuitive Surgical, maker
of the DaVinci, for minimally invasive surgery. The company designed their first-
generation surgical robot for minimally invasive cardiac surgery. Although this
application never gained a strong foothold, a group of innovative urologists applied
the platform to prostate surgery, and the modern era of robotic surgery was born.
At this point in history, robotic surgery has come to dominate minimally invasive
applications in many of the surgical subspecialties. Reconstructive efforts have been
some of the last to be fully developed. This book is dedicated to those efforts. As
you will see in the following pages, robotic reconstructive surgery has begun to gain
momentum in several key areas which we will feature in this book. The chapters
within contain applications in plastic surgery, but also in other types of reconstruc-
tion such as orthopedics and urology. Some of these are relevant because of either
cross-over with plastic surgery practice, as in some of the orthopedic work, or anal-
ogous function, as in the luminal anastomoses in urology.
Minimally invasive surgery (MIS) is only one, albeit important benefit of a surgi-
cal robot. Several applications that highlight this function are contained within the
book, such as the robotic rectus harvest and latissimus harvest. These have permit-
ted the elimination of larger incisions from open surgery, analogous to the transition
from the laparotomy to MIS. Similarly, we feature robotic surgery of the brachial
plexus as an example of how treatment paradigms can change. In this case, the abil-
ity to not only explore but perform minimally invasive nerve repair and grafting may
allow early exploration and repair to replace watchful waiting as the primary
approach to closed brachial plexus injuries.
The other benefit of surgical robotics is precision. In reconstructive surgery,
almost everything we do requires high levels of precision. The robot has 100%
vii
viii Preface
tremor elimination, and up to 5:1 motion scaling, endowing it with super-human
precision. Robotic microsurgery has emerged as the quintessential example of how
this can be applied to enhance surgeon ability and benefit patients. In this book, we
highlight both the learning curve of robotic microsurgical training and the advan-
tages of micro-robotics in a busy, microsurgery practice. In addition, new technolo-
gies are emerging to meet this need more specifically. These new robotic
microsurgical platforms promise to revolutionize microsurgical techniques and
expand our ability to anastomose smaller and smaller structures such as lymphatics.
One of the more exciting and recent advances in this book are the robotic mas-
tectomy and the robotic DIEP flap. The nipple sparing mastectomy (NSM) has
beguiled breast surgeons for years because of the difficulty in accessing areas of the
breast remote from the incision. With robotic NSM, this problem has promise of a
solution. Breast reconstruction using the DIEP flap has been the enduring standard
for autologous breast reconstruction for the last 20 years, but very little advance-
ment has been made in the primary drawback to this operation: disruption of the
abdominal wall. Using the roboDIEP, we are for the first time able to offer all the
advantages of the DIEP and the length and caliber of its pedicle through an MIS
approach with a very small fascial incision. This should change the game in abdom-
inal wall morbidity resulting from the open DIEP.
Transoral robotic surgery is a unique area that has been developed by the head
and neck surgeons to treat early stage cancer. Some of the more exciting but unex-
plored applications of TORS, however, are in cleft surgery and velopharyngeal dys-
function. In this book, we explore this technique and how it may change the way
these surgeries are currently approached.
Robotic plastic surgery is still in its early developmental phase, but we will soon
enter a steep part of the technology development curve that will provide us with
smaller, more organic machines, augmented reality systems, surgical decision algo-
rithms, much higher levels of precision, life-like haptics, and processing speeds
beyond our imaginations. This is a very exciting time to be a robotic plastic surgeon.
The chapters in this book represent some of the early forays into this new and excit-
ing discipline. I invite the reader to allow their imagination to wander, not only to
the present applications in robotic plastic surgery, but to the amazing possibilities
that lay in the future.
Houston, TX, USA Jesse C. Selber
Contents
Part I Training and Evaluation
1 Robotic Microsurgical Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Savitha Ramachandran, Taiba Alrasheed, Alberto Ballestín, Yelena
Akelina, and Ali Ghanem
2 Robotic Skills Assessment: Crowd- Sourced Evaluation in
Surgery and Future Directions in Plastic Surgery . . . . . . . . . . . . . . . . . 15
Thomas Lendvay and James Smartt
Part II Clinical Applications
3 Robotic Harvest of the Rectus Abdominis Muscle . . . . . . . . . . . . . . . . . 29
Chad M. Bailey, Geraldine T. Klein, John C. Pedersen,
Louis L. Pisters, and Jesse C. Selber
4 Robotic Breast Reconstruction with the Latissimus Dorsi Flap . . . . . . 45
Mark W. Clemens and Jesse C. Selber
5 The RoboDIEP: Robotic-Assisted Deep Inferior Epigastric
Perforator Flaps for Breast Reconstruction . . . . . . . . . . . . . . . . . . . . . . 53
Sarah N. Bishop and Jesse C. Selber
6 Robotic Nerve and Upper Extremity Surgery . . . . . . . . . . . . . . . . . . . . 61
Nicola Santelmo, Fred Xavier, and Philippe Liverneaux
7 Robotic Cleft Palate Surgery and Simulation . . . . . . . . . . . . . . . . . . . . 71
Dale J. Podolsky, David M. Fisher, Karen W. Wong Riff, Thomas
Looi, James M. Drake, and Christopher R. Forrest
8 Robotic Microsurgery in Urology Private Practice:
Advantages and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Mohamed Etafy, Rıchard A. Mendelson, Ahmet Gudeloglu,
and Sıjo J. Parekattıl
9 Robotic Nipple-Sparing Mastectomy with Immediate
Prosthetic Breast Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Benjamin Sarfati and Samuel Struk
ix
x Contents
Part III Considerations for a Robotic Plastic Surgery Practice
10 Incorporating Robotics into a Plastic Surgery Practice . . . . . . . . . . . . 113
Alice S. Yao and Lars Johan M. Sandberg
Part IV N ew Microsurgical Robotic Platforms
11 Development of a New Robotic Platform for Microsurgery . . . . . . . . . 127
Hannah Teichmann and Marco Innocenti
12 A Dedicated Robotic System for Open (Super-)Microsurgery . . . . . . . 139
Ghufran Alshaikh, Rutger M. Schols, Joost A. G. N. Wolfs,
Raimondo Cau, and Tom J. M. van Mulken
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155