Robotic System Augments Open Microsurgical Procedures

A novel surgical system allows surgeons to perform complex microsurgery and expand applications in the field of supermicrosurgery.

The Medical Microinstruments (MMI; Calci, Italy) Symani Surgical System combines the benefits of tremor reduction, motion scaling (7-20x) technologies, and miniature wristed instrumentation, that together can offer seven degrees of freedom and a dexterity that is beyond the reach of human hands. The robotic platform captures the surgeon’s hand movements, imposing an identical, scaled-down motion on the microinstruments, aiding surgeons in free-flap reconstructions, replantations, congenital malformation repairs, peripheral nerve repairs, lymphatic surgery, and other procedures.


The NanoWrist micro-surgical instruments are equipped with a miniature articulated wrist with a three millimeter outer diameter and grasping tips just 150 micron in width. The instruments are manufactured using advanced materials and novel microfabrication processes that allow motions of the human hand to be scaled down by up to almost 20-fold, while still maintaining the dexterity of the natural movement of the human wrist. At the same time, the system reduces inherent motion tremor by robotic control, allowing the use of extremely small sutures, ranging from 9-0 to 12-0 in size.

“There is a clear demand for robotics in microsurgery, as the limits of the human hand have already been reached,” said Giuseppe Maria Prisco, co-founder and CEO of MMI. “We founded MMI to develop a robotic system designed for and with microsurgeons that will improve outcomes and address unmet patient needs, particularly through supermicrosurgery techniques, which are required for lymphatic and other extremely delicate procedures.”

“Microsurgery and supermicrosurgery, as a tool, technique, and discipline, continue to evolve,” said Professor L. Scott Levin, MD, chairman of the department of orthopedic surgery at the University of Pennsylvania School of Medicine (Philadelphia, USA), and a medical advisor to MMI. “The use of robotics holds great promise to advance the specialty of microsurgery and improve care for patients affected by trauma, cancer, congenital malformations and even chronic conditions such as lymphedema.”

Microsurgery relies on excellent motor control to perform critical tasks, but its most steady, the human hand naturally trembles, moving on the order of 50-100 microns several times each second. As a result, extremely fine micro-manipulations, without the use of robotic stabilization systems, remain beyond the motor control of even the most skilled surgeon.

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