The Brabant/Limburg surgical robot MUSA-3 gives surgeons a steady hand when operating. Thanks to this auxiliary tool, more surgeons will soon be able to work on a microscale, helping patients in more hospitals. The first patient with MUSA-3 was operated on in June.

Some operations are truly delicate. Think of rerouting or reconstructing a nerve after an accident or amputation, treating lymphoedema by connecting small lymph vessels with blood vessels, complex (breast) reconstructions after cancer or suturing small blood vessels. Often, the blood vessels, lymphatic vessels and nerves to be sutured in the process are thinner than a millimetre, and the sutures themselves thinner than a hair.

Patients who need to undergo such advanced micro or even super micro surgery currently rely on a small group of specialised surgeons and centres of expertise. This is what the Brabant-based company Microsure, born from a collaboration of engineers from Eindhoven University of Technology and microsurgeons from Maastricht UMC, hopes to change soon.

They developed a robot, MUSA-3, to help perform complex microsurgical procedures. MUSA-3 stabilises and enhances the surgeon's hand movements.

This will soon allow more doctors and hospitals to do these operations, hopefully shorten waiting lists and travel times for patients, and also reduce the risk of complications such as poorly healing wounds or tissue rejection. A patient was treated with this microrobot for the first time in early June.

Operation

The operation involved a lympho-venous anastomosis in a patient who had once undergone breast cancer treatment, plastic surgeon Tom van Mulken of Maastricht UMC emailed when asked. 'That is an operation that can solve the problem of lymphoedema, which can occur when a lymph node has been removed or radiated because of breast cancer.'

Lymph fluid from the arm and breast goes to lymph nodes in the armpit, but after surgery or radiotherapy, scar tissue often develops there and the lymphatic system becomes blocked. The fluid then cannot leave, leading to a thick heavy arm. This is often stigmatising, tiring and associated with infections. It is often a lifelong problem.

Van Mulken: 'One of the solutions then is to create a bypass just before the site of the scar tissue. Here, we connect the lymphatic pathway to a vein just before the blockage, then the fluid can leave the arm. Sounds simple, but these lymphatic vessels have a diameter of 0.3 to 0.8 millimetres and have to be connected with very small sutures.'

Collaborate

The purpose of MUSA-3 is not to replace the surgeon, but to enhance human skills. It consists of a console for the surgeon and an instrument with robotic arms that stands with the patient. The surgeon looks at the screen through a digital or hybrid microscope, and controls the robotic arms with joysticks. This involves reducing movements and filtering vibrations to increase precision.

Foto: Microsure

'The collaboration between surgeon and technology provides more stability and precision during surgery,' says Tom van Mulken, founder of Microsure and plastic surgeon at MUMC+ (a collaboration of Maastricht University Hospital and Maastricht University's Faculty of Health, Medicine and Life Sciences ), in a TU/e news release. 'And that in turn increases the chances of a better outcome and faster recovery for the patient.'

Earlier versions

There were previous versions of a MUSA robot, but they did not meet all the requirements to make them suitable for use in a hospital. What is new, for example, is that the device is on a trolley so it is easy to install, can cover a sufficiently large surgical area and has great freedom of movement. And if the power fails, the arms do not fall down (on the patient), but stop moving.

Incidentally, the June operation was the second milestone for Microsure in a short time: just in May, the company received CE marking for MUSA-3, which now allows the system to be used commercially within Europe.

Opening image: Microsure