Head and neck free flap reconstruction: A prospective case series with the Symani® surgical system

Robotic surgery has undergone steady evolution in recent years. Until now, there has been no suitable robotic system for plastic reconstruction. With the Symani Surgical System, anastomoses of free flaps in the head and neck region can be performed efficiently and accurately. This prospective single-centre study aims to describe and investigate the use of robotic reconstructions in the head and neck region by oral and maxillofacial surgeons for the first time. 93 patients after ablative tumor surgery who required a free flap for reconstruction in the head and neck region were included in the study; 73 had oral squamous cell carcinoma (78.5 %). Radial forearm flap 28 (30.1 %), ulnar forearm flap 28 (30.1 %), and fibula flap 22 (23.7 %) were used most frequently. Three revision surgeries were performed, and one free flap was lost. Robotic microsurgery has a steep learning curve and can be used effectively to perform anastomoses in free flap reconstructions. The surgical spectrum of microsurgical techniques has not yet been fully explored and should be further investigated. Supermicrosurgery could benefit from the Symani robotic system in the long term.