Chronology

Published Aug 10, 2026

Updated Aug 10, 2026

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MUSA-3 receives CE mark. Microsure moves into its clinical evidence and adoption phase. May 2026.

NCT07427823 registration (ClinicalTrials.gov). Feb 12, 2026.

First-in-human RCT demonstrating the feasibility of robotic lymphaticovenous anastomosis. 2020.

MUSA-2 receives CE mark (first CE-certified microsurgical robot). 2019.

Microsure founded (Eindhoven). 2016.

Overview

MUSA® is a robotic system specifically developed for open microsurgery and supermicrosurgery by Microsure, a Dutch medical-device company based in Eindhoven.

Unlike most surgical robots, MUSA was not developed by adapting a laparoscopic robotic platform to smaller anatomy. It was designed from the outset for microsurgical procedures involving sub-millimetre blood vessels, lymphatic vessels and nerves. Microsure describes MUSA-3 as its robotic system for supermicrosurgery, combining a surgeon console with a robotic arm cart and allowing surgeons to use their own familiar microsurgical instruments through disposable adapters.

The system is particularly relevant to lymphatic surgery, free-flap reconstruction, peripheral nerve surgery and other supermicrosurgical procedures.

MUSA-3 received its CE Mark in May 2026, making it the current clinically available generation.

Microsure

Microsure originated from a collaboration between Maastricht University Medical Center+ (MUMC+) and the Eindhoven University of Technology (TU/e). The company was founded in 2016, following a clinical need identified by microsurgeons at MUMC+ and the engineering expertise available at TU/e.

The objective was unusually specific: develop a robot capable of assisting surgeons with the extremely precise movements required in open microsurgery, while preserving the surgical instruments and workflow with which microsurgeons were already familiar. This resulted in the MUSA platform.

MUSA-2: the clinical proof of concept

MUSA-2 was the generation that established the clinical credibility of the platform. It was launched in 2019 and became the first CE-certified microsurgical robot. It subsequently became the subject of several clinical studies, particularly in lymphaticovenous anastomosis (LVA) for breast-cancer-related lymphedema.  The first-in-human randomized pilot study was particularly important (1). It compared robot-assisted and manual LVA in patients with breast-cancer-related lymphedema. At three months, clinical outcomes improved and the time required to perform the anastomosis decreased substantially in the robotic group, from approximately 33 to 16 minutes during the study.  The subsequent one-year analysis included 20 patients: eight underwent robotic LVA and 12 manual LVA (2). Quality of life improved in both groups, while overall anastomotic patency was 76.5%—66.6% in the robotic group and 81.8% in the manual group. The authors concluded that robotic LVA was feasible, with clinical outcomes comparable to manual surgery. Importantly, this did not establish superiority of robotic surgery. It established feasibility.

MUSA-3

MUSA-3 represents the current generation of the platform. Its architecture consists of a surgeon console and a robotic arm cart with two robotic arms. It requires a separate digital or hybrid microscope (the surgeon operates from the console while viewing the operative field through the microscope system).

One of the defining characteristics of MUSA is that the surgeon does not need to change to proprietary robotic instruments. Instead, familiar microsurgical instruments are mounted to the robotic arms through disposable adapters. Microsure considers this an important part of maintaining the surgeon’s existing workflow.

MUSA-3 received CE Mark approval in May 2026. The current generation has now entered its clinical medical-device phase, with Microsure focusing on clinical evidence, adoption and broader commercialization.  The company is currently conducting further clinical evaluation, including a study of MUSA-3 for micro-anastomoses involving blood vessels, nerves and lymphatic vessels in free-flap, lymphatic and peripheral nerve surgery. The registered study NCT07427823 estimates 30 patients (3).  It does not have FDA clearance yet.

Limitations and open questions

The fundamental question is the same as for any surgical robot: does greater technical precision translate into better patient outcomes? The available evidence does not yet demonstrate that MUSA is clinically superior to expert manual microsurgery. The randomized LVA pilot study demonstrated feasibility, but the one-year results showed comparable, rather than superior, clinical outcomes.

That distinction, between technical feasibility and clinical benefit, will ultimately determine the future of robotic supermicrosurgery.

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Prior to commencing my venture into robotic surgery, I had established a firm grounding as an oncologic surgeon. My experience encompassed a wide range of resection and reconstructive procedures, as well as proficiency in minimally invasive surgical techniques and endoscopic surgery. These acquired skills and expertise serve as fundamental pillars for achieving success in robotic surgery.

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