It has been nearly a decade since Seminars in Plastic Surgery published its first issue exploring the topic of robotic plastic and reconstructive surgery, and I am honored to coguest edit this new issue with Dr. Jesse Selber and present the surgical and technological advances made in this field.

The advent of laparoscopic surgery in the 1980s advanced the horizons of minimally invasive surgery, and the field of robotic surgery was born thereafter. While initial conception and research into robotic surgery were funded by NASA and the military to facilitate providing medical care in forward combat areas and near space, these applications have yet to be fully realized, and the technology was licensed to Intuitive Surgical (Sunnyvale, CA), maker of the DaVinci, for minimally invasive, on-site surgery. The first robotic-assisted surgery was a cholecystectomy performed in 1997, followed by the first robotic-assisted mitral valve replacement 1 year later. Robotic assistance offers several advantages over laparoscopic surgery including improved stereoscopic visualization, physiologic tremor elimination, enhanced surgeon ergonomics, motion scaling for precision surgical motions, and many procedures that can be performed through smaller incisions than their laparoscopic counterpart.

Over the past three decades, there has been a broad application of robotic assistance in many surgical subspecialties. In parallel, robotics within plastic surgery has begun to gain momentum in several key areas that we will feature in this issue. We highlight the applications of robotic surgery from both implant-based breast reconstruction and autologous breast reconstruction. The adoption of robotics into surgeries that traditionally require large flap harvest incisions has shown promise, and interdisciplinary collaboration has increased with the robotic rectus abdominis muscle flap and the robotic latissimus dorsi muscle flap. On the opposite end of the spectrum, robotic surgery's application in super microsurgery and lymphatic surgery continues to grow with new and innovative operating systems. Our issue further highlights the pivotal role of robotics in providing access to complex and severely physically constrained anatomic sites, specifically highlighted by its applications in transoral robotic surgery for oropharyngeal reconstruction, nerve and brachial plexus surgery, as well as gender-affirming pelvic, genital, and perineal reconstruction surgeries. In this issue of Seminars, we also showcase the potential for remote robotic surgery applications in global medicine, as well as discuss its role in virtual education platforms. This issue not only explores the learning curve of robotic microsurgical training and the advantages of robotics in a busy, microsurgery practice but further aims to examine robotic surgery in the economics of medicine and hospital reimbursement.

Robotic plastic surgery is still a burgeoning area of innovation and collaboration in our field, but the last decade has shown us that the excitement around its applications has only grown. I invite the reader to explore this edition of Seminars in Plastic Surgery and take in not only our achievements in this short decade, but also begin to imagine the exciting future ahead as we further master the application of robotic surgery and marry it with advances in artificial intelligence, improved haptic feedback, and augmented reality systems. Plastic surgery is a field that is ever-changing and attracts those with a passion for innovation.

Article published online:
04 March 2024

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