{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:00:46Z","timestamp":1787932846693,"version":"build-2784847793"},"reference-count":22,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T00:00:00Z","timestamp":1751155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>(1) Background: Lymphedema is a common but underrecognized sequela of cancer treatment. Supermicrosurgical procedures such as lymphaticovenular anastomosis (LVA) and, more recently, lymph node-to-vein anastomosis (LNVA) have emerged as effective options for fluid-predominant disease. In 2024, we began performing robot-assisted LNVA using a next-generation microsurgical robot. This study describes our initial experience, technical insights, and the potential for robotics to extend the boundaries of supermicrosurgery. (2) Methods: Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon at a tertiary center. Preoperative imaging with standard and ultra-high frequency ultrasound was used to identify optimal lymph nodes and veins. Robotic LNVA was performed using the Symani Surgical System, with adaptations for motion scaling, ergonomics, and console control. Intraoperative patency was confirmed by direct washout and\/or indocyanine green (ICG) transit. (3) Results: All 22 procedures were technically successful, with 100% intraoperative patency. Anastomosis time improved from 37 to 18 min. Robotic assistance enhanced precision, eliminated tremors, and reduced the technical burden of operating at extreme submillimeter scales. (4) Conclusions: Robotic LNVA is safe, feasible, and efficient. It optimizes current techniques, offering the potential to extend surgical access below the 0.1 mm threshold, with implications for future treatment of lymphatic and possibly intracranial disease.<\/jats:p>","DOI":"10.3390\/curroncol32070377","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T12:10:31Z","timestamp":1751285431000},"page":"377","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Robot-Assisted Lymph Node-to-Vein Anastomosis: Lessons from the First 22 Cases at a High-Volume Lymphatic Supermicrosurgery Center"],"prefix":"10.3390","volume":"32","author":[{"given":"Wei F.","family":"Chen","sequence":"first","affiliation":[{"name":"Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44124, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1430-7348","authenticated-orcid":false,"given":"David C. F.","family":"Cheong","sequence":"additional","affiliation":[{"name":"Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44124, USA"},{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Tedone Clemente","sequence":"additional","affiliation":[{"name":"Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44124, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1182-3473","authenticated-orcid":false,"given":"Melis","family":"Salman","sequence":"additional","affiliation":[{"name":"Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44124, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Executive Committee of the International Society of Lymphology (2023). The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The International Society of Lymphology. Lymphology, 56, 133\u2013151.","DOI":"10.2458\/lymph.6372"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S165","DOI":"10.1097\/SAP.0000000000002689","article-title":"Advanced Technical Pearls for Successful Supermicrosurgical Lymphaticovenular Anastomosis","volume":"86","author":"Chen","year":"2021","journal-title":"Ann. Plast. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1002\/bjs.1800550609","article-title":"Surgical lymphaticovenous shunts in patients with secondary lymphoedema","volume":"55","author":"Nielubowicz","year":"1968","journal-title":"Br. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/bjs.1800550611","article-title":"Experimental lymphovenous anastomosis","volume":"55","author":"Nielubowicz","year":"1968","journal-title":"Br. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1016\/j.bjps.2021.01.005","article-title":"Lymph Node to Vein Anastomosis (LNVA) for lower extremity lymphedema","volume":"74","author":"Pak","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s40137-024-00395-y","article-title":"Advances in Surgical Lymphedema Management: The Emergence and Refinement of Lymph Node-to-Vein Anastomosis (LNVA)","volume":"12","author":"Bailey","year":"2024","journal-title":"Curr. Surg. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/jso.24332","article-title":"Lymphosome concept: Anatomical study of the lymphatic system","volume":"115","author":"Suami","year":"2017","journal-title":"J. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1055\/s-0038-1635118","article-title":"Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema","volume":"32","author":"Suami","year":"2018","journal-title":"Semin. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/j.jamcollsurg.2004.08.027","article-title":"Surgical robotics: Impact of motion scaling on task performance","volume":"199","author":"Prasad","year":"2004","journal-title":"J. Am. Coll. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, T., Li, H., Pu, T., and Yang, L. (2023). Microsurgery Robots: Applications, Design, and Development. Sensors, 23.","DOI":"10.3390\/s23208503"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/SCS.0000000000010610","article-title":"Ergonomic Considerations in Robotic-assisted Microsurgery","volume":"36","author":"Struebing","year":"2025","journal-title":"J. Craniofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e5685","DOI":"10.1097\/GOX.0000000000005685","article-title":"Robot-assisted Microsurgery: Lessons Learned from 50 Consecutive Cases","volume":"12","author":"Struebing","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mihara, M., Hara, H., Araki, J., Kikuchi, K., Narushima, M., Yamamoto, T., Iida, T., Yoshimatsu, H., Murai, N., and Mitsui, K. (2012). Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0038182"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s10439-017-1929-y","article-title":"Investigation of Shape with Patients Suffering from Unilateral Lymphoedema","volume":"46","author":"Karakashian","year":"2018","journal-title":"Ann. Biomed. Eng."},{"key":"ref_15","first-page":"4476","article-title":"Three-dimensional laser scanning as a reliable and reproducible diagnostic tool in breast cancer related lymphedema rehabilitation: A proof-of-principle study","volume":"24","author":"Losco","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s12957-020-02043-y","article-title":"An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients","volume":"18","author":"White","year":"2020","journal-title":"World J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.bjps.2019.06.041","article-title":"Multi-segment bioimpedance can assess patients with bilateral lymphedema","volume":"73","author":"Qin","year":"2020","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-022-06850-7","article-title":"Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: Clinical practice guidelines","volume":"198","author":"Shah","year":"2023","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1097\/SAP.0000000000001610","article-title":"How to Get Started Performing Supermicrosurgical Lymphaticovenular Anastomosis to Treat Lymphedema","volume":"81","author":"Chen","year":"2018","journal-title":"Ann. Plast. 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