{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:52:58Z","timestamp":1790398378312,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Background: Robotic surgical systems offer enhanced precision, motion scaling, tremor filtration, and visualization, making them highly suitable for the complex anatomical demands of plastic and reconstructive surgery. While widely implemented in other specialties, their integration in plastic surgery remains limited. This systematic review evaluates the clinical applications, outcomes, and limitations of robotic-assisted techniques in plastic and reconstructive procedures. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published between January 1980 and March 2025. Clinical studies reporting robotic applications in plastic surgery were included, while cadaveric, animal, and non-English studies were excluded. Data extraction and quality assessment were performed using Covidence and validated tools including the CARE checklist, NOS, GRADE, and SYRCLE. A total of 1428 studies were screened, and 31 met the inclusion criteria. Results: Robotic systems were primarily applied in microsurgery (n\u00a0= 16), breast reconstruction (n\u00a0= 8), and craniofacial\/aesthetic surgery (n\u00a0= 7). Common platforms included the Symani Surgical System, Da Vinci systems, and ARTAS. Robotic-assisted approaches improved precision, aesthetic outcomes, flap survival, and patient satisfaction, particularly in procedures involving lymphaticovenous anastomosis and nipple-sparing mastectomy. However, challenges included steep learning curves, longer operative times, high equipment costs, and the lack of haptic feedback. Quality assessment rated all studies as moderate. Conclusions: Robotic-assisted surgery demonstrates considerable potential in enhancing plastic and reconstructive outcomes. As systems become more compact, cost-effective, and integrated with AI and biomimetic technologies, their broader adoption is anticipated. Further high-quality studies are needed to optimize these systems and support widespread clinical implementation.<\/jats:p>","DOI":"10.3390\/s25103238","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T07:44:57Z","timestamp":1747813497000},"page":"3238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Evaluating the Clinical Utility of Robotic Systems in Plastic and Reconstructive Surgery: A Systematic Review"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5444-8925","authenticated-orcid":false,"given":"Ishith","family":"Seth","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC 3084, Australia"},{"name":"Faculty of Medicine and Surgery, Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia"},{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2813-9779","authenticated-orcid":false,"given":"Kaiyang","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7863-912X","authenticated-orcid":false,"given":"Edmond","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4092-182X","authenticated-orcid":false,"given":"Warren M.","family":"Rozen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia"},{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7332-627X","authenticated-orcid":false,"given":"Sally Kiu-Huen","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e706","DOI":"10.1097\/GOX.0000000000000659","article-title":"Redefining Plastic Surgery","volume":"4","author":"Chandra","year":"2016","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gorgy, A., Xu, H.H., Hawary, H.E., Nepon, H., Lee, J., and Vorstenbosch, J. (2024). Integrating AI into Breast Reconstruction Surgery: Exploring Opportunities, Applications, and Challenges. Plast. Surg.","DOI":"10.1177\/22925503241292349"},{"key":"ref_3","first-page":"E123","article-title":"Fifty years of free tissue transfer: The past, present and future of microsurgical reconstruction","volume":"95","author":"Graziano","year":"2025","journal-title":"Anz. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s11701-024-01921-x","article-title":"Evaluation of the MMI Symani\u00ae robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model","volume":"18","author":"Rusch","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bjps.2024.06.009","article-title":"Safety and efficacy of Symani robotic-assisted microsurgery: Assessment of vascular anastomosis patency, thrombus, and stenosis in a randomized preclinical study","volume":"96","author":"Menichini","year":"2024","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cho, J., Kim, D., Kim, T., Pak, C.J., Suh, H.P., and Hong, J.P. (2024). Further validating the robotic microsurgery platform through preclinical studies on rat femoral artery and vein. J. Reconstr. Microsurg.","DOI":"10.1055\/a-2460-4940"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/SCS.0000000000010860","article-title":"Expanding Applications and Future of Robotic Microsurgery","volume":"36","author":"Wessel","year":"2025","journal-title":"J. Craniofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bjps.2025.01.037","article-title":"Evaluation of microsurgical free flap procedures utilizing the Symani Surgical System: A preliminary analysis","volume":"102","author":"Chakari","year":"2025","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lin, L., Xu, C., Shi, Y., Zhou, C., Zhu, M., Chai, G., and Xie, L. (2021). Preliminary clinical experience of robot-assisted surgery in treatment with genioplasty. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85889-w"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.bjps.2015.03.021","article-title":"A novel technique for robot assisted latissimus dorsi flap harvest","volume":"68","author":"Chung","year":"2015","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1597\/14-077","article-title":"Transoral robotic cleft palate surgery","volume":"53","author":"Nadjmi","year":"2016","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"283","DOI":"10.4103\/ijps.IJPS_35_18","article-title":"Reconstruction with free flaps in robotic head-and-neck onco-surgeries","volume":"51","author":"Arora","year":"2018","journal-title":"Indian J. Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1245\/s10434-018-6704-2","article-title":"Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant: Technique, preliminary results and patient-reported cosmetic outcome","volume":"26","author":"Lai","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5999\/aps.2018.00052","article-title":"Early experiences with robot-assisted prosthetic breast reconstruction","volume":"46","author":"Ahn","year":"2019","journal-title":"Arch. Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/j.bjps.2020.01.030","article-title":"Robotic-assisted latissimus dorsi muscle flap for autologous chest reconstruction in Poland syndrome","volume":"73","author":"Moon","year":"2020","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1016\/j.bjps.2021.03.120","article-title":"Robot-assisted breast reconstruction using the prepectoral anterior tenting method","volume":"74","author":"Jeon","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Novo, J., Seth, I., Mon, Y., Soni, A., Elkington, O., Marcaccini, G., and Rozen, W.M. (2025). Use of Robotic Surgery in Plastic and Reconstructive Surgery: A Narrative Review. Biomimetics, 10.","DOI":"10.3390\/biomimetics10020097"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1097\/DSS.0000000000003152","article-title":"Robotically assisted recipient site preparation in hair restoration surgery: Surgical safety and clinical outcomes in 31 consecutive patients","volume":"47","author":"Kanayama","year":"2021","journal-title":"Dermatol. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1055\/s-0042-1748647","article-title":"Single-port transaxillary robot-assisted latissimus dorsi muscle flap reconstruction for Poland syndrome: Concomitant application of robotic system to contralateral augmentation mammoplasty","volume":"49","author":"Hwang","year":"2022","journal-title":"Arch. Plast. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1016\/j.bjps.2022.02.054","article-title":"Implementing the robotic deep inferior epigastric perforator flap in daily practice: A series of 10 cases","volume":"75","author":"Wittesaele","year":"2022","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jpra.2023.07.001","article-title":"Benefits of robotic-assisted lymphatic microsurgery in deep anatomical planes","volume":"37","author":"Weinzierl","year":"2023","journal-title":"JPRAS Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"590e","DOI":"10.1097\/PRS.0000000000010470","article-title":"Novel port placement in robot-assisted DIEP flap harvest improves visibility and bilateral DIEP access: Early controlled cohort study","volume":"152","author":"Tsai","year":"2023","journal-title":"Plast. Reconst. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e6221","DOI":"10.1097\/GOX.0000000000006221","article-title":"Technical strategies and learning curve in robotic-assisted peripheral nerve surgery","volume":"12","author":"Aman","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/15533506241262568","article-title":"The use of the Symani Surgical System\u00ae in emergency hand trauma care","volume":"31","author":"Dastagir","year":"2024","journal-title":"Surg. Innov."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.jcms.2024.03.017","article-title":"First experience using a novel microsurgical robotic device for free flap surgery in cranio- and maxillofacial surgery","volume":"52","author":"Tolksdorf","year":"2024","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e31227","DOI":"10.1002\/micr.31227","article-title":"Fully telemetric robotic microsurgery: Clinical experience wth 23 cases","volume":"44","author":"Gorji","year":"2024","journal-title":"Microsurgery"},{"key":"ref_27","first-page":"354","article-title":"Advances in reconstructive robotic microsurgery in the extremity","volume":"36","author":"Watson","year":"2024","journal-title":"J. Craniofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1001\/jamasurg.2023.6999","article-title":"Safety and feasibility of single-port robotic-assisted nipple-sparing mastectomy","volume":"159","author":"Farr","year":"2024","journal-title":"JAMA Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"523e","DOI":"10.1097\/PRS.0000000000010716","article-title":"Robot-assisted capsulectomy with immediate reimplantation in breast reconstruction","volume":"153","author":"Oh","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1097\/PRS.0000000000011205","article-title":"Conventional versus robot-assisted immediate breast reconstruction: Reconstructive outcome and patient-reported outcome measures","volume":"154","author":"Kim","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_31","first-page":"645","article-title":"Six steps for a successful aesthetic free flap reconstruction after minimally invasive mastectomy: A retrospective case-control study","volume":"110","author":"Wong","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1007\/s11701-024-01937-3","article-title":"100 anastomoses: A two-year single-center experience with robotic-assisted micro- and supermicrosurgery for lymphatic reconstruction","volume":"18","author":"Weinzierl","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"108602","DOI":"10.1016\/j.ejso.2024.108602","article-title":"Learning curve for robot-assisted nipple-sparing mastectomy: A single institution experience","volume":"50","author":"Jung","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e4013","DOI":"10.1097\/GOX.0000000000004013","article-title":"Early Experience Using a New Robotic Microsurgical System for Lymphatic Surgery","volume":"10","author":"Lindenblatt","year":"2022","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e5240","DOI":"10.1097\/GOX.0000000000005240","article-title":"First Series of Free Flap Reconstruction Using a Dedicated Robotic System in a Multidisciplinary Microsurgical Center","volume":"11","author":"Beier","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/15533506231222438","article-title":"Robotic Microsurgery in Extremity Reconstruction\u2014Experience With a Novel Robotic System","volume":"31","author":"Besmens","year":"2024","journal-title":"Surg. Innov."},{"key":"ref_37","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_38","doi-asserted-by":"crossref","first-page":"e6164","DOI":"10.1097\/GOX.0000000000006164","article-title":"Robotic-assisted Lymphovenous Anastomosis of the Central Lymphatic System","volume":"12","author":"Grunherz","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jpra.2022.09.002","article-title":"Exploring the learning curve of a new robotic microsurgical system for microsurgery","volume":"34","author":"Barbon","year":"2022","journal-title":"JPRAS Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1167\/tvst.11.8.13","article-title":"A Novel Microsurgical Robot: Preliminary Feasibility Test in Ophthalmic Field","volume":"11","author":"Savastano","year":"2022","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1038\/am.2016.73","article-title":"Gecko-inspired chitosan adhesive for tissue repair","volume":"8","author":"Frost","year":"2016","journal-title":"NPG Asia Mater."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"ojad084","DOI":"10.1093\/asjof\/ojad084","article-title":"Comparing the efficacy of large language models ChatGPT, BARD, and Bing AI in providing information on rhinoplasty: An observational study","volume":"5","author":"Seth","year":"2023","journal-title":"Aesthetic Surg. J. Open Forum"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Marcaccini, G., Seth, I., and Cuomo, R. (2024). Letter on: \u201cArtificial Intelligence: Enhancing Scientific Presentations in Aesthetic Surgery\u201d. Aesthetic Plast Surg., Epub ahead of print.","DOI":"10.1007\/s00266-024-04592-z"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Seth, I., Bulloch, G., Joseph, K., Hunter-Smith, D.J., and Rozen, W.M. (2023). Use of artificial intelligence in the advancement of breast surgery and implications for breast reconstruction: A narrative review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155143"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Seth, I., Lim, B., Lu, P.Y., Xie, Y., Cuomo, R., Ng, S.K., Rozen, W.M., and Sofiadellis, F. (2024). Digital twins use in plastic surgery: A systematic review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247861"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1111\/andr.13543","article-title":"Vasovasostomy: A systematic review and meta-analysis comparing macroscopic, microsurgical, and robot-assisted microsurgical techniques","volume":"12","author":"Seth","year":"2024","journal-title":"Andrology"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/10\/3238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:36:27Z","timestamp":1760031387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/10\/3238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["s25103238"],"URL":"https:\/\/doi.org\/10.3390\/s25103238","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,21]]}}}