Robotic Lymphovenous Anastomosis

Robotic lymphaticovenous anastomosis (RoboLVA or RLVA) has opened a new realm where cutting-edge technology converges with the artistry of microsurgical reconstructions. What 30 years ago seemed like a utopia is now a reality, as robotic systems such as Symani Medical Microinstruments (MMI) augment the surgeons’ skills, pushing the boundaries of what is microsurgically possible. In this chapter, we summarize the current state of robotic microsurgery and discuss the requirements and challenges of this new frontier. The training process, magnification options, robotic platform deployment, and robotic LVA technique are all detailed and discussed. Results from our first 23 robotic LVA cases are presented, totaling 64 anastomoses, all the while addressing the main limitations and disadvantages of the lymphatic robotic approach. Cost-efficiency and ethics or robotic LVA are discussed, as these two factors will ultimately tip the balance between future widespread adoption and twenty-first-century surgical novelty with limited patient reach.