Background: Robotic assisted anastomoses have been successfully performed in totally endoscopic coronary artery bypass grafting on the beating heart. The feasibility of robotic-assisted microanastomosis in plastic and reconstructive surgery is in evolution.

Methods: 32 1 mm diameter coronary arteries were harvested from explanted pig hearts and cannulated with a catheter attached to a "mini pump" for continuous infusion with saline. Micro arteriotomy scissors were adapted for use by the Zeus robotic arms and an intravascular shunt was placed within the artery following arteriotomy to keep a bloodless field. Another piece of artery as next anastomosed to the shunted vessel using an end to side technique using either 8-0 prolene suture or Nitinol U-clips. Prolene sutures were used to construct a continuous (n=40) or interrupted anastomosis (n=40). Nitinol U-clips were used to construct ten anastomoses. The newly constructed anastomoses were examined for integrity of sutures, clinical leak (using saline injection) and technical imperfections by direct inspection.

Results: patency rates for all surgeons (n=3) were identical for the different methods of anastomosis (95 % Nitinol clips, 94 % interrupted prolene, and 94 % for continuous prolene). However, there was more pursestringing effect with the continuous anastomosis technique. The utility of interrupted sutures was evident in the ease of handling of short suture material within the video endoscopic filed of vision from a console monitor system.

Conclusions: Microanastomoses using robotic assistance in an explanted model demonstrated the feasibility of using this technology. Although patency rates were identical for all techniques, there was less "pursetringing" effect with interupted suture technique. This may ave relevance in the construct of more pliable veins in flap construction. The technique with robotics is also facilitated by short sutures and lack of necessity in tying knots using the Nitinol U-clips.