217 Early Experience With Robotic Microvascular Anastomoses

INTRODUCTION: Robotics are becoming increasingly widespread within various neurosurgical subspecialties. The adoption of robotic technology within vascular neurosurgery is of great interest, but data pertaining to its feasibility is currently limited. METHODS: 68 sutures were performed and assessed. 6 anastomoses (3 robotic and 3 hand-sewn) were performed on 1-1.5 mm caliber tubes and recorded with the operative microscope. We separately compared interrupted sutures (from needle insertion until third knot) and running sutures (from needle insertion until stitch pull-out). Average suture timing across all groups was compared using an unpaired student’s T test. RESULTS: We compared 29 robotic sutures to 39 hand-sewn sutures. There was no significant difference between the average time/stitch for the robotic running sutures (n = 18) and the hand-sewn running sutures (n = 16) (45.6 s vs. 41.2 s; p-value = 0.3). The average for the first robotic anastomosis (n=7) was significantly longer than the second (n = 11) (56.3 vs. 38.3; p = .03). The first robotic anastomosis had a negative slope (-8.5). Interestingly, both the second robotic end-to-side anastomosis and the hand-sewn control had shallow positive slopes (1.5 and 2.6). The average of the robotic interrupted sutures (n = 11) was significantly longer than the hand-sewn (n = 23) (286 s vs. 70; p<.01). The average time for the first robotic interrupted anastomosis (n = 7) was significantly longer than the second (n = 4) (366.9 s vs. 144.5; p=0.008). CONCLUSIONS: Our results indicate that the learning curve for suturing robotic microanastomoses is short and encouraging. Similar performance to hand-sewn running sutures is possible robotically with minimal practice. Although the learning curve for the interrupted group was encouraging, we only reached similar results to hand-sewn in the very last robotic sutures. Overall, the use of robotics warrants further study for potential use in cerebrovascular bypass procedures.