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To date, microsurgical robotic platforms have been used exclusively for the anastomosis of vessels in lymphatic surgery. This study reports on the first total robotic-assisted lymphovenous anastomosis and further highlights future directions for microsurgical robotic assistance in lymphatic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Symani\u00ae Surgical System, two patients with lower extremity lymphedema received total robotic-assisted lymphovenous anastomoses. This included robotic-assisted microdissection of lymphatic and venous vessels followed by performance of a robotic-assisted lymphovenous anastomosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of four complete robotic-assisted lymphovenous anastomoses were performed in the lower legs of two patients. All anastomoses showed patency in the intraoperative indocyanine green imaging, demonstrating the feasibility of total robotic-assisted lymphovenous anastomosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Total robotic-assisted lymphovenous anastomosis is a safe and feasible surgical technique. Microsurgical robotic assistance enhances the surgeon\u2019s precision and improves the ergonomics, thus ameliorating surgical endurance. Further studies are required to compare this new technique to a traditional manual approach regarding the surgical outcome and cost efficiency. Future technical refinements such as a greater variety of microsurgical instruments and the possibility of automated robotic surgery could further expand the application of robotic assistance in lymphatic surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11548-026-03589-0","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T02:09:51Z","timestamp":1772590191000},"page":"869-875","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The first total robotic-assisted lymphovenous anastomosis: prospects for innovation and future development"],"prefix":"10.1007","volume":"21","author":[{"given":"Carlotta","family":"Imholz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen E.","family":"Zurfluh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0293-1004","authenticated-orcid":false,"given":"Nicole","family":"Lindenblatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"issue":"6","key":"3589_CR1","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/j.jaad.2017.03.022","volume":"77","author":"AA Grada","year":"2017","unstructured":"Grada AA, Phillips TJ (2017) Lymphedema: pathophysiology and clinical manifestations. 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