【Overview】

At Lymphedema Clinic Tokyo, we are committed not only to providing individualized lymphedema care, but also to advancing the science that supports safer and more precise microsurgical treatment.

In this peer-reviewed study, Dr. Makoto Mihara, Director of Lymphedema Clinic Tokyo, served as a lead author and collaborated with engineers from Sony Group Corporation to develop and evaluate the world’s first microsurgery-assisting robot equipped with an automated instrument exchange system .

This research was published in PRS Global Open, an international open-access journal affiliated with the American Society of Plastic Surgeons.

 

【Why This Research Matters】

Supermicrosurgery, including lymphaticovenous anastomosis (LVA), requires extreme precision, stability, and seamless coordination between surgeons and assistants.

However, conventional robotic systems often interrupt surgical flow due to slow or manual instrument exchange.

 

This study addresses that challenge by introducing:

・Automated instrument exchange completed in approximately 9 seconds

・A miniature surgical tool kit positioned entirely within the operative field

・Reduced dependence on surgical assistants, supporting greater surgeon autonomy

 

【Key Research Findings】

・The robotic system successfully performed 128 consecutive automated instrument exchanges without error

・100% vascular patency was achieved in rat supermicrosurgical models (vessel diameter: 0.35–0.8 mm)

・While anastomosis time was longer than expert manual surgery, procedural stability and reproducibility were improved

・The system enabled not only suturing, but also vessel dissection, trimming, anastomosis, and patency assessment

 

These findings suggest that robotic assistance may contribute to standardization and safety in complex microsurgical procedures, particularly in ultra-fine vessels.

 

【Comment from Dr. Makoto Mihara MD, Ph.D】

“Our goal is not to replace surgeons, but to support precision, safety, and reproducibility in supermicrosurgery.

This research reflects our long-term vision to integrate advanced technology into lymphedema care in a responsible and evidence-based manner.”

 

【How This Research Connects to Patient Care】

At Lymphedema Clinic Tokyo, we combine:

・Conservative therapy

・Day-surgery lymphaticovenous anastomosis (LVA)

・Continuous integration of scientific evidence and technological innovation

 

While this robotic system is currently at a research and development stage, our clinical practice already reflects the principles demonstrated in this study: meticulous technique, team efficiency, and patient safety.

 

【Reference (Open Access)】

Mihara M, Hara H, Wakana K, et al.

The First Microsurgery-Assisting Robot Equipped With an Automatic Instrument Exchange System and a Miniature Tool Kit.

Plastic and Reconstructive Surgery Global Open. 2025;13:e7072.

 

DOI: 10.1097/GOX.0000000000007072

(Published online September 10, 2025) 

https://www.mominoki-shinryosho.jp/our-paper2/

 

【Further Reading】

A curated list of research studies introduced by our clinic is available at the bottom of the following page:

👉 https://www.english-mominoki-shinryosho.net/research/

 

【❓ Frequently Asked Questions (FAQ)】

Research on Microsurgery-Assisting Robotics

Lymphedema Clinic Tokyo

 

Q1. What is this research about?

A.

This study reports the development and evaluation of the world’s first microsurgery-assisting robot equipped with an automated instrument exchange system.

The research focuses on improving precision, workflow stability, and surgeon autonomy in supermicrosurgery, including procedures such as lymphaticovenous anastomosis (LVA) 

the_first_microsurgery_assistin…

.

 

Q2. Who conducted this research?

A.

The study was led by Dr. Makoto Mihara, Director of Lymphedema Clinic Tokyo, in collaboration with engineers from Sony Group Corporation and academic partners.

It was published in the peer-reviewed international journal PRS Global Open.

 

 

Q3. Why is automated instrument exchange important in microsurgery?

A.

In supermicrosurgery, surgeons frequently switch instruments while operating on vessels smaller than 1 mm.

Manual instrument exchange can interrupt concentration and prolong operative time.

This robotic system completes instrument exchange automatically in approximately 9 seconds, helping maintain surgical focus and workflow continuity.

 

 

Q4. What were the main results of the study?

A.

Key findings include:

Successful completion of 128 consecutive automated instrument exchanges without error

100% vascular patency in rat supermicrosurgical models

Improved procedural stability and reproducibility, despite longer suturing times compared with expert manual surgery

These results suggest potential benefits for standardization and safety in complex microsurgical procedures.

 

 

Q5. Does this robot replace surgeons?

A.

No.

The robot is designed to support surgeons, not replace them.

It assists with precision, stability, and instrument handling, while all surgical decisions and techniques remain under the surgeon’s control.

 

 

Q6. Is this robotic system currently used in patient surgery?

A.

At present, this system is at the research and development stage.

While it is not yet used in routine clinical practice, the principles demonstrated—precision, safety, and reproducibility—are already applied in daily microsurgical care at Lymphedema Clinic Tokyo.

 

 

Q7. How is this research relevant to patients with lymphedema?

A.

Lymphedema surgery often involves extremely fine lymphatic vessels.

Technologies that enhance surgical accuracy and consistency may contribute to safer procedures and more reliable outcomes in the future.

This research represents a step toward that goal.

 

 

Q8. Where can I read the original research paper?

A.

The full article is available as an open-access publication:

Mihara M, Hara H, Wakana K, et al.

Plastic and Reconstructive Surgery Global Open. 2025;13:e7072.

DOI: 10.1097/GOX.0000000000007072 

the_first_microsurgery_assistin…

 

 

Q9. Are there other research studies introduced by your clinic?

A.

Yes.

A curated list of research studies recommended by Lymphedema Clinic Tokyo is available at the bottom of the following page:

https://www.english-mominoki-shinryosho.net/research/