Early implementation and learning curve of robotic-assisted microsurgery for delayed lymphatic reconstruction in breast cancer related lymphedema: A single institution’s experience
Nicole K. Le, MD, MPH1; Diana Hanks, BS1; Nagashree Rao, MS, MPH2; Tina Tavares, RN1; Brielle Weinstein, MD1, Aurora Kareh MD1; Nicholas J. Panetta, MD1
1 Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
2 College of Public Health, University of South Florida, Tampa, FL, USA
Introduction-
•Breast cancer–related lymphedema (BCRL) remains a common, debilitating outcome of axillary node dissection
•Traditional lymphatic reconstruction is effective yet highly technically demanding
•Robotic microsurgery offers:
•Tremor filtration
•Enhanced precision
•Superior 3D visualization
•Improved ergonomics → potentially better outcomes
Objectives-
•To evaluate early clinical outcomes and the learning curve of robotic-assisted delayed lymphatic reconstruction for BCRL
Methods-
•Patients with chronic BCRL underwent delayed lymphatic reconstruction using the Symani Surgical System (Medical Microinstruments, Calci, Italy)
•From January to August 2025 with at least 3 months of follow up
•Reverse arm mapping- ICG and isosulfan blue
•Demographic data, operative times, and perioperative outcomes were analyzed
•Learning curve assessment- correlation testing
Results-
•29 patients underwent robotic-assisted reconstruction
•113 lymphaticovenular anastomoses
•Mean patient age was 62 ± 11 years
•Mean BMI was 27 ± 4.1 kg/m²
•Mean operative time was 230.3 ± 63.0 minutes, averaging 71.4 ± 34.9 minutes per anastomosis.
•A learning curve plateau was observed after approximately 20 cases (p = 0.48).
•Mean follow-up of 91.6 ± 69.5 days, patients demonstrated early improvements in limb volume and quality of life
•No major complications, including infection, hematoma, seroma, or wound dehiscence.
Discussion-
•Robotic-assisted microsurgery for delayed lymphatic reconstruction in BCRL is feasible and safe, with encouraging early outcomes
•Further studies with larger cohorts and longer follow-up are warranted to confirm its long-term efficacy and reproducibility
•Learning curve
•One size fits all setup
•OR positioning
•Technical skills
References-
•Dvan Mulken TJM, Schols RM, Scharmga AMJ, et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial. Nat Commun. Feb 11 2020;11(1):757. doi:10.1038/s41467-019-14188-w
