{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T22:54:09Z","timestamp":1792364049617,"version":"4.4.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Robotic microsurgery offers important advantages in vascular anastomoses and nerve sutures, particularly for structures\u2009&lt;\u20091\u00a0mm as required in supermicrosurgery. The Symani\n                    <jats:sup>\u00ae<\/jats:sup>\n                    surgical robot provides micrometric movements and tremor elimination through motion scaling, improving precision and reducing operator fatigue. Although several studies have investigated Symani-related training and learning curves, most were conducted on synthetic or in vitro animal models. The few studies performed on in vivo rat models involve microvascular surgeons with many years of experience in traditional microsurgery, rather than residents with no experience in robotic microsurgery and only limited exposure to conventional microsurgery. During the Advanced Microsurgery Course 2025 in Naples (Italy), held between May and December 2025, 14 participants with no prior robotic microsurgery experience and minimal conventional microsurgical training performed first a practice session on a silicone synthetic model to become familiar with the robot, and subsequently on in vivo murine models using the Symani\n                    <jats:sup>\u00ae<\/jats:sup>\n                    robot. Data from the in vivo exercise were collected and compared, focusing on time required to complete individual knots and intraoperative complications. Participants demonstrated rapid acquisition of operative skills, showing a reduction in suturing time during in vivo procedures, which indicates a fast adaptation to the robotic platform even among inexperienced operators. The Symani\n                    <jats:sup>\u00ae<\/jats:sup>\n                    robotic microsurgery system is intuitive and associated with a steep learning curve, even for users with no prior exposure to robotic microsurgery and only basic training in traditional microsurgery. This supports its potential as an effective training platform and clinical tool in supermicrosurgery.\n                  <\/jats:p>","DOI":"10.1007\/s11701-026-03506-2","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:20:20Z","timestamp":1784539220000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["In vivo microsurgical training with the symani\u00ae robot: early experience and feasibility"],"prefix":"10.1007","volume":"20","author":[{"given":"Alessandro","family":"Piperno","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Palombo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Francesca","family":"Pennarola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Otera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigismondo","family":"Castaldo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Tos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Pagnotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"3506_CR1","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s11701-025-02629-2","volume":"19","author":"A Piperno","year":"2025","unstructured":"Piperno A, Palombo E, Pagnotta A (2025) Use of the Symani\u00ae microscopic surgical robot in hand surgery and operating room setup. J Robot Surg 19:519. https:\/\/doi.org\/10.1007\/s11701-025-02629-2","journal-title":"J Robot Surg"},{"key":"3506_CR2","doi-asserted-by":"publisher","first-page":"763","DOI":"10.3390\/life15050763","volume":"15","author":"F Struebing","year":"2025","unstructured":"Struebing F, Weigel J, Gazyakan E et al (2025) Robot-Assisted Microsurgery Has a Steeper Learning Curve in Microsurgical Novices. Life 15:763. https:\/\/doi.org\/10.3390\/life15050763","journal-title":"Life"},{"key":"3506_CR3","doi-asserted-by":"publisher","first-page":"7859","DOI":"10.1245\/s10434-022-12033-x","volume":"29","author":"A Ballest\u00edn","year":"2022","unstructured":"Ballest\u00edn A, Malzone G, Menichini G et al (2022) New Robotic System with Wristed Microinstruments Allows Precise Reconstructive Microsurgery: Preclinical Study. Ann Surg Oncol 29:7859\u20137867. https:\/\/doi.org\/10.1245\/s10434-022-12033-x","journal-title":"Ann Surg Oncol"},{"key":"3506_CR4","doi-asserted-by":"publisher","first-page":"14003","DOI":"10.1038\/s41598-023-41143-z","volume":"13","author":"G Malzone","year":"2023","unstructured":"Malzone G, Menichini G, Innocenti M, Ballest\u00edn A (2023) Microsurgical robotic system enables the performance of microvascular anastomoses: a randomized in vivo preclinical trial. Sci Rep 13:14003. https:\/\/doi.org\/10.1038\/s41598-023-41143-z","journal-title":"Sci Rep"},{"key":"3506_CR5","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1055\/a-2460-4940","volume":"41","author":"J Cho","year":"2025","unstructured":"Cho J, Kim D, Kim T et al (2025) Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and Vein. J Reconstr Microsurg 41:595\u2013605. https:\/\/doi.org\/10.1055\/a-2460-4940","journal-title":"J Reconstr Microsurg"},{"key":"3506_CR6","doi-asserted-by":"publisher","first-page":"101767","DOI":"10.1016\/j.jvscit.2025.101767","volume":"11","author":"M Rusch","year":"2025","unstructured":"Rusch M, Hoffmann G, Berndt R, Rusch R (2025) Feasibility study to evaluate the MMI Symani\u00ae robotic system for microsurgical techniques in an in-vitro circulation model. J Vasc Surg Cases Innov Tech 11:101767. https:\/\/doi.org\/10.1016\/j.jvscit.2025.101767","journal-title":"J Vasc Surg Cases Innov Tech"},{"key":"3506_CR7","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1007\/s11701-024-01921-x","volume":"18","author":"M Rusch","year":"2024","unstructured":"Rusch M, Hoffmann G, Wieker H et al (2024) Evaluation of the MMI Symani\u00ae robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model. J Robot Surg 18:168. https:\/\/doi.org\/10.1007\/s11701-024-01921-x","journal-title":"J Robot Surg"},{"key":"3506_CR8","doi-asserted-by":"publisher","first-page":"A067","DOI":"10.1055\/s-0034-1373969","volume":"30","author":"PMI Tos","year":"2014","unstructured":"Tos PMI, Pagnotta A, Cozzolino S (2014) Establishing a Comprehensive Program in Microsurgical Training - The Advanced Course of the Italian Society for Microsurgery. J Reconstr Microsurg 30:A067. https:\/\/doi.org\/10.1055\/s-0034-1373969","journal-title":"J Reconstr Microsurg"},{"key":"3506_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1142\/S0218810411004984","volume":"16","author":"I Panchulidze","year":"2011","unstructured":"Panchulidze I, Berner S, Mantovani G, Liverneaux P (2011) Is haptic feedback necessary to microsurgical suturing? Comparative study of 9\/0 and 10\/0 knot tying operated by 24 surgeons. Hand Surg 16:1\u20133. https:\/\/doi.org\/10.1142\/S0218810411004984","journal-title":"Hand Surg"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03506-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03506-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03506-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T22:02:47Z","timestamp":1784584967000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03506-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3506"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03506-2","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"28 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no potential conflicts of interest with respect to the research, authorship, and\/or publication of this article.","order":1,"name":"Ethics","label":"Conflicting interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted under Ministerial Authorization No. 354\/2025-PR (Ref. prot. C6AC4.48), within the project entitled \u201cBasic and Advanced Microsurgery Training\u201d. Animals were maintained under general anesthesia and, at the end of the procedures, were euthanized in accordance with the provisions of the ministerial authorization.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participants signed a document declaring their awareness of Italian Law No. 413 of 12 October 1993 concerning conscientious objection to the use of animal models. All animals were obtained from authorized breeding facilities and were housed and cared for in accordance with Legislative Decree 26\/2014 (Directive 2010\/63\/EU). The project was conducted on a non-profit basis and had no commercial purpose.","order":3,"name":"Ethics","label":"Compliance with ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This study did not involve human participants or human data.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"651"}}