Feasibility of a robotic exoscope in microsurgical diabetic foot reconstruction: a pilot study and narrative review

Purpose: This study aimed to assess the feasibility of a robotic exoscope (Robotic- Scope) for microvascular anastomosis in microsurgical diabetic-foot reconstruction compared with a conventional operating microscope, and to contextualize its use through a brief narrative review.Methods: This was a single-center, retrospective observational study of patients undergoing free tissue transfer for diabetic foot defects between August 2022 and January 2023. Patients were allocated according to the intraoperative visualization modality used: group A (robotic exoscope) or group B (operating microscope). The primary intraoperative variable was anastomosis time per vessel, while postoperative outcomes included flap survival and complications.Results: Six patients were included (five males; mean age, 53.17±12.73 years; mean defect size, 32.86±19.79 cm²), with two patients in group A and four in group B. The mean anastomosis time per vessel was 20.6±6.47 minutes in group A and 18.0±3.86 minutes in group B (p=0.342). All flaps in group A survived, while in group B, there was one case of partial flap necrosis and one instance of venous congestion requiring reexploration.Conclusion: In this pilot experience, a robotic exoscope enabled safe and efficient microvascular anastomosis for diabetic-foot free-flap reconstruction, with no significant difference in anastomosis time or early flap outcomes compared with the operating microscope. These findings support feasibility and justify larger, prospective studies to confirm efficacy, quantify ergonomic benefits, and refine clinical indications.