Feasibility and Current Applications of the Symani Surgical System: A Systematic Review

Background:. The application of robotics in microsurgery remains to be widely established. Currently, the Symani Surgical System (Medical Microinstruments, Pisa, Italy) remains the only commercially available robotic platform dedicated to microsurgery. This systematic review evaluated the current ev...

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Main Authors: Yu Jin Jeong, MD, Amanda E. Yung, MD, Daniel Steffens, PhD, Sophie Hogan, PhD, Jonathan R. Clark, AM, MBiostats, Sydney Ch’ng, MBBS, PhD, FRACS, FACS
Format: Article
Language:English
Published: Wolters Kluwer 2025-07-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006939
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author Yu Jin Jeong, MD
Amanda E. Yung, MD
Daniel Steffens, PhD
Sophie Hogan, PhD
Jonathan R. Clark, AM, MBiostats
Sydney Ch’ng, MBBS, PhD, FRACS, FACS
author_facet Yu Jin Jeong, MD
Amanda E. Yung, MD
Daniel Steffens, PhD
Sophie Hogan, PhD
Jonathan R. Clark, AM, MBiostats
Sydney Ch’ng, MBBS, PhD, FRACS, FACS
author_sort Yu Jin Jeong, MD
collection DOAJ
description Background:. The application of robotics in microsurgery remains to be widely established. Currently, the Symani Surgical System (Medical Microinstruments, Pisa, Italy) remains the only commercially available robotic platform dedicated to microsurgery. This systematic review evaluated the current evidence surrounding the Symani, including current applications, operating time and learning curve, ergonomics, limitations, and clinical outcomes. Methods:. A comprehensive search was conducted via Ovid in MEDLINE, Embase, and the Cochrane Library from inception to September 2024. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in PROSPERO (CRD42024616049). Results:. The initial search identified 98 records, of which 7 preclinical and 17 clinical studies were included. All included studies were conducted within European centers, with an increasing number of publications over the last 3 years (2022, n = 3; 2023, n = 7; 2024, n = 14). Most clinical studies were case reports (n = 6) or series (n = 9). The clinical application of the Symani for lymphatic surgery (n = 7), nerve repair (n = 4), and vascular anastomosis (n = 11) have been described. Early data suggest longer anastomotic times and steep learning curves with the Symani. High rates of intraoperative anastomosis patency (>90%) have been demonstrated, but remain to be evaluated in head-to-head comparisons with conventional methods. Conclusions:. Early clinical outcomes demonstrate the feasibility of Symani-assisted microsurgery. Comparative studies are required to assess the benefit of robotic-assisted microsurgery over conventional methods, particularly for vessels less than 0.8 mm in diameter, that is, supermicrosurgery.
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spelling doaj-art-d564966ea6714699a70302b7b1eb27902025-08-20T02:45:46ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-07-01137e693910.1097/GOX.0000000000006939202507000-00028Feasibility and Current Applications of the Symani Surgical System: A Systematic ReviewYu Jin Jeong, MD0Amanda E. Yung, MD1Daniel Steffens, PhD2Sophie Hogan, PhD3Jonathan R. Clark, AM, MBiostats4Sydney Ch’ng, MBBS, PhD, FRACS, FACS5From the * Royal Prince Alfred Hospital, Sydney, New South Wales, Australia† Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia† Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia§ Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia† Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia† Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, AustraliaBackground:. The application of robotics in microsurgery remains to be widely established. Currently, the Symani Surgical System (Medical Microinstruments, Pisa, Italy) remains the only commercially available robotic platform dedicated to microsurgery. This systematic review evaluated the current evidence surrounding the Symani, including current applications, operating time and learning curve, ergonomics, limitations, and clinical outcomes. Methods:. A comprehensive search was conducted via Ovid in MEDLINE, Embase, and the Cochrane Library from inception to September 2024. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in PROSPERO (CRD42024616049). Results:. The initial search identified 98 records, of which 7 preclinical and 17 clinical studies were included. All included studies were conducted within European centers, with an increasing number of publications over the last 3 years (2022, n = 3; 2023, n = 7; 2024, n = 14). Most clinical studies were case reports (n = 6) or series (n = 9). The clinical application of the Symani for lymphatic surgery (n = 7), nerve repair (n = 4), and vascular anastomosis (n = 11) have been described. Early data suggest longer anastomotic times and steep learning curves with the Symani. High rates of intraoperative anastomosis patency (>90%) have been demonstrated, but remain to be evaluated in head-to-head comparisons with conventional methods. Conclusions:. Early clinical outcomes demonstrate the feasibility of Symani-assisted microsurgery. Comparative studies are required to assess the benefit of robotic-assisted microsurgery over conventional methods, particularly for vessels less than 0.8 mm in diameter, that is, supermicrosurgery.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006939
spellingShingle Yu Jin Jeong, MD
Amanda E. Yung, MD
Daniel Steffens, PhD
Sophie Hogan, PhD
Jonathan R. Clark, AM, MBiostats
Sydney Ch’ng, MBBS, PhD, FRACS, FACS
Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
Plastic and Reconstructive Surgery, Global Open
title Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
title_full Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
title_fullStr Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
title_full_unstemmed Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
title_short Feasibility and Current Applications of the Symani Surgical System: A Systematic Review
title_sort feasibility and current applications of the symani surgical system a systematic review
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006939
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