Robotic Lymphatic Supermicrosurgery (Symani System)

Robotics lymphatic supermicrosrugery is a cutting-edge surgical approach that used a robotic platform to perform extremely delicate operations omn lymphatic vessels, which can be as small as .3 mm in diameter. The Symani Surgical System, developed by Medical Microinstruments (MMI), is the primary device used for this purpose. It was purpose-built for microsurgery and supermicrosurgery, featuring the world's smallest wristed robotic instruments, tremor filtration, and motion scaling of up to 20x. “The system is FDA-cleared and CE marked, and is primarily used to treat lymphedema — chronic swelling caused by a damaged lymphatic system, most often as a result of cancer treatment such as lymph node removal. As noted by researchers, robotic assistance provides complete tremor amortization and motion scaling, leading to increased precision and unparalleled steadiness, particularly when handling or preparing extremely small and fragile lymphatic vessels” (Grünherz et al.).

During the procedure, the surgeon sits at a console and controls the Symani's robotic arms using chopstick-like controllers, while viewing the surgical field through a high-resolution 3D exoscope. The robot's NanoWrist instruments are guided into the body and used to connect blocked lymphatic vessels directly to nearby veins, a procedure called lymphovenous anastomosis (LVA), or to transplant healthy lymph tissue to affected areas. Imaging tools such as CT, ultrasound, and indocyanine green lymphography are used to map vessels before and during the operation. “The use of the robot in combination with a 3D exoscope for visualization enabled the surgeon to efficiently perform anastomosis in the depth of the axilla after extensive scar tissue resection, despite a narrow access to the operating field” (von Reibnitz et al.).

The benefits of robotic lymphatic supermicrosurgery are significant for patients who have exhausted conservative treatments like compression garments and manual drainage. Because the procedure is minimally invasive and highly precise, patients experience less tissue trauma and faster recovery compared to open surgery. Clinical outcomes have shown measurable reductions in limb swelling, improved quality of life, and reduced need for ongoing compression therapy. The robotic system also reduces physical strain on surgeons during lengthy procedures, and its learning curve is more manageable than traditional supermicrosurgery, potentially expanding access to more patients worldwide.

Written by Malak Ibrahim at Incisionary

References

Rusch, R., Trentmann, J., Hummitzsch, L., & et al. (2025). Feasibility study to evaluate the MMI Symani robotic system for microsurgical techniques in an in-vitro circulation model [Image]. Journal of Vascular Surgery Cases, Innovations and Techniques, 11, 101767. https://www.jvscit.org/article/S2468-4287(25)00049-8/fulltext

Grünherz, L., & et al. (2023). Robotic-assisted microsurgery for lymphedema treatment. Plastic and Aesthetic Research, 10, 101. https://www.oaepublish.com/articles/2347-9264.2022.101

von Reibnitz, D., Weinzierl, A., Barbon, C., & et al. (2023). Benefits of robotic-assisted lymphatic microsurgery in deep anatomical planes. PMC / National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10403710/