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Recently, according to foreign media VRTnws, the University Hospital of Brussels (UZ Bressels) in Belgium carried out the world's first operation using two surgical robots at the same time.
The hospital performed a lymph node transplant for a patient with lymphedema, and the two surgical robots used are da Vinci Xi and Symani, the world's first FDA-approved microsurgical robot.
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Dual surgical robots
Jointly overcome international problems
The World Health Organization classifies lymphedema as the second most disabling disease. According to statistics, more than 1/5 of the people who undergo lymph node dissection during breast cancer surgery have edema, and there are more than 3 million lymphedema patients in the mainland.
Lymphedema after breast cancer surgery is secondary to axillary lymph node dissection, and the treatment of local tissue edema caused by the obstruction of lymphatic fluid return and the abnormal increase of fluid in the interstitial space is also an international problem.
As a chronic disease, conservative treatment, such as wearing pressure arm sleeves every day and intensive manual therapy, requires long-term maintenance to ensure stable efficacy, which has a great impact on patients' lives and is difficult to adhere to for a long time.
At present, it is generally accepted internationally that lymphatic surgery is the only treatment that can truly reverse lymphedema. Among them, lymph node transplantation is to transplant lymph nodes from other areas to the edematous arm, which plays the role of pumping lymph fluid, simply put, it is to replenish the excised lymph nodes and their functions, because the technical threshold is high, so it is only carried out in a few centers in China.
In 2018, UZ Brussel became the first hospital in Europe to perform robotic-assisted lymph node transplantation and continues to explore this area.
The first patient who underwent a double-surgical robotic lymph node transplant developed lymphedema and swelling of his arm after breast surgery.
The da Vinci Xi, who was involved in the operation, is a robotic system widely used in surgery and is mainly used to perform endoscopic surgeries, while lymph node transplantation involves reconnecting tiny blood vessels to restore blood flow or redirect fluid, and da Vinci Xi has shown limitations in this type of surgery.
The Symani surgical robot compensates for this shortcoming, with a system designed specifically for microsurgery, with a miniature wrist instrument that is the smallest wrist surgical instrument in the world (3 mm outer diameter and only 150 microns wide at the tip) with 7 degrees of freedom and easy handling of small sutures from 9-0 to 12-0 in size, allowing doctors to suture, ligate and anastomose tiny anatomical structures such as blood vessels, nerves and lymphatic vessels.
UZ Brussel successfully performed the first lymph node transplant with a dual surgical robot in the same space. Abdominal surgeon Martijn Schoneveld said: "Robots allow us to release the necessary tissue from the stomach in a more dexterous way with smaller scars and finer instruments. It reduces the surgeon's hand movements by a factor of 20 and eliminates even minimal vibrations in the hand. Patients also recover faster after surgery. ”
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The only one approved by the FDA
Microsurgical platform
Recently, there has also been significant progress in the globalization of the Symani surgical robot.
On April 8, 2024, Medical Microinstruments, Inc. (MMI) announced that the Symani Surgical Robotic System is now FDA-approved for marketing in the U.S. as the only commercially available reconstructive microsurgery platform in the U.S. Previously, the Symani system received CE certification in 2019 and has so far performed nearly 1,000 surgeries in the EU.
This means that the field of microsurgery has entered the era of robotic surgical assistance.
It is worth noting that in February this year, MMI officially announced that it had completed a Series C financing of 110 million US dollars (about 800 million yuan). It is reported that this round of financing was led by Fidelity Management & Research Company. MMI said in a press release that this funding round marks the largest investment in microsurgical robots in history.
According to the data, MMI has received more than 900 million yuan in financing since its establishment in Pisa, Italy in 2015, and even the European Investment Bank (EIB) has given it 15 million euros of financial support.
The company said the funding will be used to help expand indications and support ongoing commercialisation efforts for the Symani Surgical System in Europe, accelerate commercialisation plans in the U.S. and Asia-Pacific region, and advance clinical studies.
In China, MMI has also made a layout. In December 2023, Hangzhou Qiushi Hospital announced that in order to promote the development of super microsurgery, Matt lamey, vice president of MMI, came to Hangzhou Qiushi Hospital with the Symani system to visit Hangzhou Qiushi Hospital and show the key components of the Symani system to microsurgery experts.
Hangzhou Qiushi Hospital will join forces with MMI to build a long-term strategic cooperative relationship. In February 2024, Professor Xie Qingping of Qiushi Hospital will visit Asan Medical Center in Seoul, South Korea as a visiting professor to discuss the neck surgery operation of the Symani robot with Professor JP HOOM of the center.
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Fill a gap in the market
The competition for surgical robots has escalated
At present, the global surgical robot market is fiercely competitive, especially in the fields of laparoscopy and orthopedics, but it is still a blue ocean in the field of microsurgery, and there are a large number of unmet needs in many departments such as otolaryngology, lymphatic surgery, neurosurgery, and plastic surgery.
At present, in addition to the Symani system, the MUSA system developed by the Dutch company Microsure obtained CE certification in 2019, and domestic companies such as Antai Jingwei and Dishi Medical have also entered the field of microsurgery.
Microsure
MUSA
Founded in 2016 by the Eindhoven University of Technology and the Maastricht University Medical Center, Microsure is the world's first open microsurgical robot, which can connect blood vessels as small as 0.3 mm and can be integrated with the Carl Zeiss Tivato 700 visualization system for microsurgery, such as lymphatic surgery, free flap surgery, hand surgery, etc.
Ontai Micro Fine
Antai Micro has built the world's first robot platform focusing on small and delicate surgery, and at the same time successfully realized the whole process of the surgical robot system without jitter operation.
At present, the product has been able to achieve micron-level single-step movement, which fully meets the high-precision operation requirements of microsurgery. The robot's head-wrist structure is less than 3mm in diameter, the smallest in the world, and can accurately anastomosis 0.3mm blood vessels, lymphatic vessels and nerves.
Its general-purpose microsurgical robots, ophthalmic surgical robots, otological surgical robots, and transgastrointestinal endoscopic robots are all expected to achieve larger-scale commercial applications in the future.
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With the development of science and technology, the field of surgical robot technology is gradually catching up, and the replacement of manual work by robots is becoming more and more sufficient.