Microsurgery Robot: From Nylén's Microscope to ABB

A microsurgery robot helps surgeons stitch blood vessels, lymphatic vessels and nerves that are often thinner than a millimetre. This post follows reconstructive microsurgery from the first operating microscope in 1921, through the surgeons who first reattached limbs and moved free flaps, to supermicrosurgery, where vessels are a few tenths of a millimetre wide and a surgeon's natural tremor becomes the limit. It then looks at the Symani robot, now used for lymphedema and reconstruction, at this autumn's news, and at how ABB robots might one day help build the tiny instruments these systems use. ABB does not make such a product today.

Surgeons at Landstuhl Regional Medical Center perform the hospital's first microvascular reconstruction on a cancer patient, December 2021. Photo: Marcy Sanchez, U.S. Army via Wikimedia Commons (public domain)

How surgeons learned to sew vessels under a microscope

Microsurgery began with a microscope built for ear operations. In 1921 the Swedish otolaryngologist Carl-Olof Nylén modified a monocular Brinell-Leitz microscope at the University of Stockholm for use in surgery, and a year later Gunnar Holmgren replaced it with a binocular version. For decades the operating microscope stayed mostly in ear and eye surgery. Vascular work arrived in 1960, when Julius Jacobson at the University of Vermont joined vessels as small as 1.4 mm under a microscope and coined the word microsurgery.

A surgeon demonstrates at an operating microscope during a microsurgery course at ZUHMC, October 2013. Photo: محمد عبد الغني / Wikimedia Commons (public domain)

Reattaching limbs came soon after. In Boston in 1962 Robert Malt's team replanted the arm of a child injured by a train, and in 1963 Harold Kleinert and Mort Kasdan in Louisville revascularized a partly amputated finger. Harry Buncke reported in 1964 that he had replanted a rabbit's ear in his garage with home made instruments, joining vessels of about 1 mm. In February 1966 surgeons in Shanghai moved a second toe to a thumb. By the early 1970s the free flap, which moves living tissue together with its own vessels, had become a common one stage reconstruction.

Surgeons wearing magnifying loupes during the first microvascular reconstruction at Landstuhl, 2021. Photo: Marcy Sanchez, U.S. Army via Wikimedia Commons (public domain)

Then the work got smaller. Isao Koshima's group in Japan began joining flap vessels and lymphatic vessels below 0.8 mm, and Koshima defined supermicrosurgery as anastomosis of vessels of 0.3 to 0.8 mm and of single nerve fascicles. His group's technique of connecting blocked lymph vessels to tiny veins, called lymphaticovenular anastomosis, is the basis of much lymphedema surgery. At this scale a surgeon's hand tremor is about as large as the stitch, and Nicholas Panetta of USF Health has said that only a handful of surgeons have the skills to treat the condition this way.

Compression forceps for Yasargil clips made in Tuttlingen, Germany, an example of fine surgical hand instruments. Photo: Wellcome Collection via Wikimedia Commons (CC BY 4.0)

Microsurgery robot cases in 2026

The leading system is Symani, made by MMI (Medical Microinstruments) and built in Pisa, Italy. It received FDA De Novo authorization in 2024, which made it the first surgical robot available in the US for reconstructive microsurgery. The surgeon sits at a console, and the robot filters out tremor and scales hand movements down by a factor the surgeon picks between 7 and 20. Its wristed instruments can suture vessels and nerves as small as about 0.2 mm. MMI says surgeons have used it in around 3,000 procedures.

A surgeon with loupes works on a microvascular anastomosis at Landstuhl Regional Medical Center, 2021. Photo: Marcy Sanchez, U.S. Army via Wikimedia Commons (public domain)

Several things happened this autumn. On 16 September 2026 the European Investment Bank and Angelini Ventures announced a €17 million investment in MMI. In Florida, Panetta, who performed the first fully robotic lymphovenous bypass in the US in December 2025, is using Symani for lymphedema patients at Tampa General Hospital, which was named a lymphatic disease centre of excellence at the end of September. In England, surgeons at Broomfield Hospital in Essex tried out the £1.4 million robot to see whether it could help with reconstruction, nerve repair and lymphoedema care.

The Landstuhl team during the hospital's first microvascular reconstruction and anastomosis procedure, 2021. Photo: Marcy Sanchez, U.S. Army via Wikimedia Commons (public domain)

ABB robots do not operate on patients, and ABB has no microsurgery robot. They could fit earlier in the chain, in making the instruments. Jaws and wrists only a few millimetres long need clean, repeatable assembly and inspection, which is the kind of small part work single arm YuMi IRB 14050 cells already do on medical device lines, for example GE Healthcare's prototype line in Helsinki. We cover that side in our post on medical device manufacturing. No one has reported using YuMi or GoFa for microsurgical instruments, so this remains an idea.

A single arm YuMi IRB 14050 in its cell on GE Healthcare's prototype line in Helsinki. Photo: ABB

Where robotic microsurgery goes next

For patients at home, the hope is wider access. Lymphedema often follows breast cancer surgery and lymph node removal, and it can leave an arm or leg swollen for life. If robots let more surgeons do supermicrosurgery reliably, more hospitals could offer lymphatic bypass to people who now manage the swelling with compression garments alone. A systematic review published in September 2026 described microsurgical treatment as safe, effective and durable for preventing lymphoedema in the leg, which strengthens the case for training more teams.

Doctors practise microsurgery under operating microscopes at a simulation and training centre in Jakarta, 2018. Photo: ICTEC FKUI RSCM / Wikimedia Commons (CC BY-SA 4.0)

Hospitals are also asking these robots to do more. By December 2025 Symani had FDA clearance for NanoWrist dissection instruments, so the robot can now dissect tissue as well as suture it. Bohdan Pomahac of Yale leads the PRECISE post market study, and MMI lists uses from head and neck reconstruction to research on lymphatic drainage in Alzheimer's disease. Each new instrument type is another small, precise part that has to be built and tested, and that is where compact robots, planned and checked in RobotStudio, could find work.

ABB YuMi assembling small parts beside a lab worker. Photo: ABB

Plenty is still unsolved. A system costing around £1.4 million is hard to justify for a hospital that does few microsurgical cases, and long term outcome data is still being collected, partly through studies like PRECISE. Surgeons have to learn to operate through a console with a scaled view of their own movements, which takes training time. Patients also need clear information about what the robot does and what the surgeon still controls during the operation.

ABB's mobile YuMi concept, a dual arm robot on a wheeled base, in a hospital lab corridor. Photo: ABB

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