Arch Hand Microsurg 2019; 24(4): 358-367  
Robotic Microsurgery Training for Robot Assisted Reconstructive Surgery
Jong Won Hong, Dongwoo Shin, Dong Won Lee, Won Jai Lee
Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: Jong Won Hong
Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Korea
TEL: +82-2-2228-2210, FAX: +82-2-393-6947, E-mail: hsaturn@hanmail.net, ORCID: https://orcid.org/0000-0002-7762-0940
Received: August 28, 2019; Revised: October 1, 2019; Accepted: October 16, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Recent advances in robotic surgery have affected not only surgery for visceral organs but also head and neck cancer surgery and microsurgery. The authors intended to analyze and share experience gained from performing microanastomosis training in a new robotic surgery system.
Methods: Robotic microanastomosis training was performed using Da Vinci Xi. The robot arm used two black diamond forceps, one Potts scissor, and one vision camera. First, basic robotic surgery skills were trained with Da Vinci Skill Simulator training. Actual microanastomosis practice was performed using artificial blood vessel, chicken wing and porcine leg.
Results: Three simulation training sessions were performed and five vessel anastomosis were performed. A total of 8 vascular anastomosis were performed, and anastomosis for one vessel took 31-57 minutes. The number of sutures used was more than one initially due to suture material damage, but one suture was used after four anastomosis. In the anastomosis time analysis with porcine legs, the actual anastomosis process took 2 minutes 15 seconds±41 seconds per stitch. The vascular anastomosis interval took more time than vascular anastomosis itself due to robot arm change and camera movement.
Conclusion: Robotic microsurgery training was not difficult process for surgeons who had undergone conventional microsurgery. However, more training was needed to replace the robot arm and move the camera. In the long term, mechanical improvements in diamond forceps and camera resolution were necessary. In order to master robotic microsurgery, surgeons must get used to robotic surgery system through simulation training.
Keywords: Microsurgery, Robotics, Anastomosis, Training


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