Robotic Microsurgery Optimization

  • Brahmbhatt, Jamin V. (Personalized Urology & Robotics, The PUR Clinic, South Lake Hospital) ;
  • Gudeloglu, Ahmet (Personalized Urology & Robotics, The PUR Clinic, Memorial Ankara Hospital) ;
  • Liverneaux, Philippe (Department of Hand Surgery, Strasbourg University Hospitals) ;
  • Parekattil, Sijo J. (Personalized Urology & Robotics, The PUR Clinic, South Lake Hospital)
  • Received : 2013.02.07
  • Accepted : 2013.07.31
  • Published : 2014.05.15


The increased application of the da Vinci robotic platform (Intuitive Surgical Inc.) for microsurgery has led to the development of new adjunctive surgical instrumentation. In microsurgery, the robotic platform can provide high definition $12{\times}-15{\times}$ digital magnification, broader range of motion, fine instrument handling with decreased tremor, reduced surgeon fatigue, and improved surgical productivity. This paper presents novel adjunctive tools that provide enhanced optical magnification, micro-Doppler sensing of vessels down to a 1-mm size, vein mapping capabilities, hydro-dissection, micro-ablation technology (with minimal thermal spread-$CO_2$ laser technology), and confocal microscopy to provide imaging at a cellular level. Microsurgical outcomes from the use of these tools in the management of patients with infertility and chronic groin and testicular pain are reviewed. All these instruments have been adapted for the robotic console and enhance the robot-assisted microsurgery experience. As the popularity of robot-assisted microsurgery grows, so will its breadth of instrumentation.



  1. Parekattil SJ, Cohen MS. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol 2010;20:75-9.
  2. Mamelak AN, Drazin D, Shirzadi A, et al. Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM(R)). J Clin Neurosci 2012; 19:306-9.
  3. Hyams ES, Perlmutter M, Stifelman MD. A prospective evaluation of the utility of laparoscopic Doppler technology during minimally invasive partial nephrectomy. Urology 2011; 77:617-20.
  4. Cocuzza M, Pagani R, Coelho R, et al. The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply. Fertil Steril 2010;93:2396-9.
  5. Parekattil S, Moran M. Instruments. In: Liverneaux PA, Berner SH, Bednar MS, et al., editors. Telemicrosurgery: robot assisted microsurgery. Paris: Springer; 2013. p.31-42.
  6. Toth S, Vajda J, Pasztor E, et al. Separation of the tumor and brain surface by "water jet" in cases of meningiomas. J Neurooncol 1987;5:117-24.
  7. Menovsky T, De Ridder D. Hydrodissection versus high-pressure water jet dissection. Microsurgery 2007;27:354.
  8. Parekattil SJ, Gudeloglu A, Brahmbhatt JV, et al. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol 2013;190:265-70.
  9. Tulikangas PK, Smith T, Falcone T, et al. Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 2001;75:806-10.
  10. Quaas AM, Einarsson JI, Srouji S, et al. Robotic myomectomy: a review of indications and techniques. Rev Obstet Gynecol 2010;3:185-91.
  11. Vincent R, Bittermann AJ, Oates J, et al. KTP versus $CO_{2}$ laser fiber stapedotomy for primary otosclerosis: results of a new comparative series with the otology-neurotology database. Otol Neurotol 2012;33:928-33.
  12. Strehle EM. Making the invisible visible: near-infrared spectroscopy and phlebotomy in children. Telemed J E Health 2010;16:889-93.
  13. Phipps K, Modic A, O'Riordan MA, et al. A randomized trial of the Vein Viewer versus standard technique for placement of peripherally inserted central catheters (PICCs) in neonates. J Perinatol 2012;32:498-501.
  14. Sumiyama K, Kiesslich R, Ohya TR, et al. In vivo imaging of enteric neuronal networks in humans using confocal laser endomicroscopy. Gastroenterology 2012;143:1152-3.

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