Dr. Nicholas Panetta, chief of the Plastic Surgery Institute at Tampa General Hospital and chair of the University of South Florida Health Morsani College of Medicine Department of Plastic Surgery, believes that investing in robotic technologies can dramatically improve the surgical experience.
He led a fully robotic lymphovenous bypass, from incision to closure, using FDA-cleared NanoWrist Dissection Instruments on the Symani Surgical System on Dec. 5. It was the first time the surgery was performed in the U.S. utilizing the technology.
The procedure is designed to help individuals with lymphedema, a condition that causes swelling, often in limbs, due to a buildup of lymph fluid in soft tissues. A lymphovenous bypass helps decrease the swelling by connecting blocked lymphatic vessels to adjacent small veins. This creates a new drainage route for the fluid.
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The Symani Surgical System, developed by Jacksonville-based Medical Microinstruments Inc., consists of “smaller robotic components” and “enhanced controls.” This allows surgeons to more effectively operate on microscopic vessels and nerves, according to Tampa General.
The company has also developed a series of NanoWrist Dissection Instruments, such as scissors, for its robotic technology. An agreement to bring the system to Tampa General and USF Health was signed in November 2024.
“This is an opportunity to increase and improve the precision with which we have been able to reconstruct these microscopic vessels historically,” Panetta said. “What that is going to allow us to do is not only let patients achieve better outcomes, but it’s also affording us the opportunity to intervene at the disease process at an earlier stage where you have an opportunity to make a bigger difference.”
To exemplify, he explained how vessels are delicate and small when a person first experiences symptoms of lymphedema.
“It’s very technically challenging to sew those vessels, and the robot is allowing us to approach those patients with a degree of precision and accuracy and confirmation right on the table that we have good flow.”
However, over time, a patient’s lymphatic system can undergo irreversible damage. This is why it is important to be proactive with treatment, Panetta continued.
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In January, he first implemented the Symani Surgical System technology in surgery. Initially, it was only used for certain components of the procedure. This allowed the surgeon and his colleagues to learn how to operate the system.
The robotic technology is controlled by using forceps, or as Panetta calls them, “chopsticks.” These translate the surgeon’s movements over to the robotic arms. This can “completely eliminate” tremors and increase accuracy.
“We had the glide path of months of really doing the surgery, not in a comprehensive way, but building out the skillset,” he explained. “The team was trained up and ready to go.”
The system can also make treatment more accessible.
“There’s far fewer surgeons trained with the skills necessary to perform these surgeries worldwide than the number of patients who need help,” Panetta added. “This technology is going to empower and enable more surgeons with the ability technically to intervene.”
