Supermicrosurgery could lengthen the reach of robotics

Robotic microsurgery can not only improve care for existing procedures but enable procedures that have […]

Robotic microsurgery can not only improve care for existing procedures but enable procedures that have never been done before.

Mark Toland, Medical Microinstruments


In consumer technology, everything is getting smaller. TVs are now as thin as a notebook and early cellphones the size of a small brick have been replaced by slim devices that easily slide into our pockets. By making technology smaller, it becomes more agile and easier to use. The same is true for medical technology.

However, the race to make technology smaller in medicine has life-saving potential, especially in medical robotics, a rapidly expanding field that is expected to reach $27 billion in value by 2027. I attribute much of that growth to the untapped potential in medical procedures in which robotics can improve outcomes, reduce readmissions and limit complications. Not only can robotic devices make existing procedures safer and more reproducible, but the evolution of smaller instruments and more sophisticated software and data-integration enable procedures that have never been attempted and create entirely new fields of medicine.

Evolving from micro- to supermicrosurgery

Microsurgery is the manipulation and suturing of very small anatomy such as vessels, ducts or nerves, performed under high visual magnification. Until recently, the capabilities of human hands limited the size of the anatomy that could be addressed, and therefore, which procedures physicians could successfully perform.

By making surgical instrumentation smaller, adding wrist-like mobility to the distal end and manipulating it with a robot, we can reduce physiological tremor and scale the surgeon’s hand movements to enable procedures that seemed unimaginable just a few years ago.

Interest in robotic microsurgery is growing because recent technological developments have brought new treatment options to conditions that affect broad patient populations across a range of disease states. For example, breast cancer survivors who suffer from lymphedema have no cure, only life-long treatments with poor results. Thanks to the advent of supermicrosurgery, which enables surgeons to reconnect the lymphatic channels, patients can avoid permanent damage and the need for ongoing interventions. By advancing microsurgery with robotic assistance, more surgeons will be able to perform these complex and delicate procedures that afflict nearly 250 million people worldwide, including one million people in the U.S.

In plastic surgery, robotic technology allows surgeons to treat trauma with a competency never seen before. They can reattach severed digits and rebuild limbs for victims of car crashes. Also, neurosurgeons have an opportunity to mitigate the risks associated with brain surgery through robotics by minimizing the size of the incision they need to make.

Over the next few years, the robotics field will explore how small we can go and how far we can push the limits of surgical capability within microsurgery and supermicrosurgery — connecting vessels that are less than 0.8 mm in diameter. Even minor advancements will open the door for expanding areas of medicine such as pediatric surgery, particularly with newborns and infants, where precision is crucial. These emerging practices will allow us to repair the tiny vessels and nerves and address procedures that are well beyond the scope of manual surgery.

The golden age of robotics

Since the outbreak of the COVID-19 pandemic, the public has scrutinized care delivery in an unprecedented way. The crisis has exposed many inefficiencies in healthcare, but especially the need to use technology more effectively. Providers are completing more robot-assisted procedures every year and the pandemic has created an even greater appreciation for the technology’s ability to reduce morbidity and truncate the length of hospital stays. More than ever, patients want to spend as little time as possible in the hospital and improved outcomes from robotic surgery may offer a solution.

The pandemic also begs the question of how robotic platforms can limit the spread of communicable disease. Robotic procedures inherently create physical distance between the physician and patient in a traditional model, but online robotic systems can execute remote procedures, in which the operating physician is in a different room, or even in a different country. Additionally, many microsurgical procedures treat emergent conditions and remote capability can empower surgeons to start treatment from home before they even arrive at the hospital.

The number of companies in the robotic space also shows the industry-wide belief in the technology. From the largest healthcare companies in the world, like Siemens Healthineers and Johnson & Johnson, to startups that have yet to enter the arena, the field has never been more crowded.

Consumer technology will always move faster than the highly regulated field of medical devices, but this decade promises the introduction of more devices that are as sleek as a flatscreen TV. Particularly in microsurgical robotics, the confluence of the pandemic and emerging technologies that are on the verge of major disruption will contribute to a better, safer healthcare system for patients around the world.

Mark Toland is the CEO of Medical Microinstruments (MMI SpA), a surgical robotics company dedicated to improving clinical outcomes for patients undergoing microsurgery.

The opinions expressed in this blog post are the author’s only and do not necessarily reflect those of Medical Design and Outsourcing or its employees.

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