The robotic microsurgery field is moving fast. But the clinical reality is still remarkably simple.
In Europe and the US, the two dedicated systems currently clinically available are Symani (MMI) and MUSA-3 (Microsure). Other platforms are emerging. KAI in China is already entering clinical development through the NMPA innovative-device pathway, while Sony remains at the prototype stage. And there are many others in earlier stages of development.
But what are these robots actually solving? For conventional microsurgery, the answer is not obvious. Experienced reconstructive surgeons already perform microvascular anastomoses routinely. The goal would be to perform endoscopic microsutures, but currently available systems such as the da Vinci are too coarse for this purpose, while dedicated microsurgical robots have too limited a working range.
The other challenge is supermicrosurgery: working with lymphatic vessels and other structures below the millimetre range. This brings us to lymphaticovenous anastomosis (LVA). There is growing evidence that LVA can improve lymphedema, although the literature remains heterogeneous. But when we look specifically at robotic LVA, the results so far are mostly reassuring rather than revolutionary: robotic and manual procedures have produced comparable clinical outcomes. A systematic review published in 2026 reached essentially the same conclusion.
So the obvious question is: why use a robot if the outcomes are the same? Motion scaling and tremor elimination certainly make the suturing easier and potentially more reproducible. But suturing is only one part of LVA. Identifying the lymphatics, mapping them, exposing them and deciding which vessels are worth connecting may be far more important than the actual microsuture.
And there is another issue: indication. We still need to understand which patients and which lymphatic anatomy truly benefit from reconstruction. REMIND is another intriguing development, but it remains an ambitious hypothesis.
And this raises a broader question. Will dedicated microsurgical robots become widespread before robotic autonomy reaches the same task? The current dedicated robots are trying to solve:
“How can we make a human surgeon better at microsuturing?”
Autonomous microsurgery asks a more disruptive question:
“Why does the surgeon have to perform the microsuturing at all?”
That is a fundamentally different proposition, and there are several developments toward autonomous robotic microsuturing.
For now, I remain sceptical about the widespread clinical utility of robotic-assisted microsurgery. The technology is impressive. But the real question is not whether robots can microsuture; is whether they can make microsurgery clinically better.
J Granell. Aug 11, 2026
Also see our 2025 post on robotic microsurgery.
References
Brown H, Brown RA, Lenkiu L, SamSam A, Lopez J, Sawh-Martinez R. Robotic-assisted Supermicrosurgery in Plastic Surgery: A Systematic Literature Review. Plast Reconstr Surg Glob Open. 2025 Jul 17;13(7):e6912. doi: 10.1097/GOX.0000000000006912
Imholz C, Schaller C, Watson JA, Zurfluh CE, Grigorean A, Lindenblatt N. Robotic-assisted lymphovenous anastomosis to treat periorbital lymphedema and systematic review of lymphatic reconstruction of face and neck lymphedema. J Robot Surg. 2025 Jul 12;19(1):380. doi: 10.1007/s11701-025-02552-6.
Sorenson TJ, Lisk R, Jacobson AB, Jacobson A, Levine JP. Hybrid Reconstruction in Head and Neck Surgery: Integration of Virtual Planning, Navigation, and Robotic Microsurgery. J Clin Med. 2026 Apr 14;15(8):2963. doi: 10.3390/jcm15082963.
Sorenson TJ, Chopoorian A, Tran D, Al Shammari A, Prince AC, Jacobson A, Levine JP. Symani-Assisted Microsurgery in Head and Neck Reconstruction: A Systematic Review of Indications, Techniques, and Pooled Analysis of Clinical Outcomes. Microsurgery. 2026 Jul;46(5):e70262. doi: 10.1002/micr.70262.