Microsurgery is a highly specialized technique used to connect tiny blood vessels. With the remote-controlled Symani Surgical System, surgeons sit in a unique chair and use hand controllers, which reduce natural hand tremors, to perform the delicate technique while a 3D screen magnifies the operating area.

Chien, who performed the surgery, told KTLA 5 “Rich on Tech” reporter Rich DeMuro the system allows for remarkable precision when connecting vessels thinner than a human hair.

“This robot and the three-dimensional aspect of the visualization allows us to add efficiency and precision to these very difficult cases,” Chien said.

Cetrulo, director of the Division of Plastic Surgery and the General William and Willa Dean Lyon Family Chair in Reconstructive and Plastic Surgery in honor of Randolph Sherman, MD, added, “What we’re watching on the screen, it could look normal to us, but in reality, it’s absolutely tiny.”

Cetrulo told DeMuro the surgery performed at Cedars-Sinai was a “100 percent success” and it could “open up a whole-new avenue of treatments for patients for diseases we never even considered treating.”

The surgeons noted robot-assisted microsurgery could one day be used for brain, abdomen and chest surgeries.

“These tools allow us to use our mastery in a level of precision and a level of dedication that was not previously possible,” Chien told DeMuro. 

Click here to watch the complete segment on KTLA 5.

Cedars-Sinai has successfully performed the first robot-assisted microsurgical head and neck cancer reconstructive surgery in the United States after the robot device received Food and Drug Administration approval for the procedure, marking a significant milestone in surgical advancements.

This procedure underscores Cedars-Sinai's commitment to staying at the forefront of medical innovation and adopting leading-edge surgical techniques that positively enhance patient care and improve outcomes.

The surgery was performed by Victor Chien, MD, who utilized the Symani Surgical System. Chien said the robot enabled him and his team to perform a complex microsurgical procedure with a higher level of precision and control than conventional methods to operate on micro blood vessels thinner than a human hair.

“The surgery demonstrates the microsurgical platform’s remarkable ability in lending greater precision and care when handling tissue in small and diseased vessels,” said Chien, a plastic surgeon in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “By removing the limitations that come with natural tremor in a human hand, the robot helped us execute this procedure in an efficient manner.”

Microsurgery is a highly specialized technique that involves connecting tiny vessels to restore blood flow or redirect fluid during surgical procedures. The microsurgery robot is designed to augment a microsurgeon’s capability to carry out surgery at the micro level by adding precision and control for extremely delicate procedures where surgical options may otherwise be limited. Additionally, Chien noted that robotic assistance greatly enhances 3D visualization and dexterity, enabling skilled microsurgeons to navigate complex areas more easily.

“Enlisting the technology potentially minimizes scarring and tissue damage, and I expect the added precision will ultimately increase operative efficiency,” Chien said.

Besides head and neck reconstruction surgery, the robot can be utilized for other complex procedures, such as breast reconstruction following cancer treatment; lower extremity microsurgical reconstruction, which involves microsurgery to repair tissues in the lower limbs following injury, disease or congenital defects; and lymphovenous bypass procedure for lymphedema, a procedure involving rerouting blocked lymphatic vessels to reduce fluid buildup caused by complications from radiation therapy.

“We are the first program in the Western U.S. to have microsurgical robotic capabilities and to perform a wide variety of successful cases using the device,” said Curtis L. Cetrulo Jr., MD, vice chair of Research in the Jim and Eleanor Randall Department of Surgery and director of the Division of Plastic Surgery at Cedars-Sinai. “We are building a robust corps of highly skilled surgeons and fellows trained in robot-assisted microsurgical technique, and we are excited to provide these innovative treatment options to our patients.”

Read more from the Cedars-Sinai Blog: Pioneering Advances in Surgery

Cedars-Sinai, part of a national multicenter consortium, will be responsible for developing protocols for the procurement and preservation of donor tissue as well as the eye transplant surgeries themselves. The Cedars-Sinai effort is being led by Curtis L. Cetrulo Jr., MD, vice chair of Research in the Jim and Eleanor Randall Department of Surgery and director of the Division of Plastic Surgery at Cedars-Sinai.

“Vision loss affects over 7 million Americans and this award represents an opportunity to really move the needle in our treatment of blindness. With this funding, I’m confident we can make progress toward eye transplantation,” Cetrulo said. “As the only clinically active vascularized composite allotransplantation program approved for face and eye transplantation on the West Coast, we are in a unique position to design the protocols that will allow for successful optic nerve connection and regeneration. We will also be addressing preservation of the donor eye tissue in transit to safeguard the optic nerve and retina, which are very sensitive to periods of decreased blood flow.”

Cedars-Sinai joins several partners, including the University of Colorado Anschutz Medical Campus, the effort’s primary award recipient. The other partners are Johns Hopkins University, University of Wisconsin, Indiana University, University of Southern California, the National Eye Institute and the Foundation for Fighting Blindness. The ARPA-H funding for the project totals up to $46 million, with up to $6 million dedicated to Cedars-Sinai’s clinical surgical efforts.

ARPA-H is a federal agency established to advance high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial activity. 

In its clinical transplantation practice, Cedars-Sinai will employ the robotic Symani Surgical System, which was recently acquired by the hospital. Currently, Cedars-Sinai is the only institution on the West Coast utilizing this new and highly specialized robotic microsurgery technology, which scales down the surgeon’s movements significantly for extreme precision.

“This is just another example of how the Department of Surgery at Cedars-Sinai strives to be at the forefront of the most innovative and life-changing procedures,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai and the Linda and Jim Lippman Chair in Surgical Oncology. “The work our team is doing on this project has the potential to transform clinical practice and impact the lives of millions of people around the globe.”

Cedars-Sinai is a leader in treating eye disease with novel approaches. Previously, Clive Svendsen, PhD, professor of Biomedical Sciences and Medicine and executive director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, received a $10.5 million grant from the California Institute for Regenerative Medicine (CIRM) to launch a clinical trial testing treatments for retinitis pigmentosa, an inherited eye disease with no known cure.

Read more from the Cedars-Sinai Blog: Pioneering Advances in Surgery

Cetrulo is the second physician to fill the chair, which was initially held by the late Randolph Sherman, MD, and was founded by the Lyon family to advance training and research into new technologies to treat patients with complicated health conditions.

“It is a distinct honor to continue the work of Dr. Sherman, and I am grateful to the Lyon family for their generous support of our research at Cedars-Sinai,” said Cetrulo, also the director of Vascularized Composite Allotransplantation Program Development.  

Cetrulo, who joined Cedars-Sinai in late 2023, is an expert in complex adult and pediatric reconstructive microsurgery, hand surgery, breast reconstruction and burn reconstruction. Prior to joining Cedars-Sinai, he was an associate professor of Surgery at Harvard Medical School. He also served as Massachusetts General Hospital’s director of the Reconstructive Transplantation Service and director of the Vascularized Composite Allotransplantation Laboratory at the Center for Transplantation Sciences.

In addition to his clinical care, Cetrulo is known for his pioneering research. Cetrulo’s research has been published in more than 150 peer-reviewed medical journals. He has made significant research contributions to xenotransplantation, the process of transplanting tissues or organs between different species. This includes the first-in-human clinical trial at Massachusetts General, during which genetically modified laboratory pig skin was used to heal burn patients’ wounds. Cetrulo received an award from the American Burn Association for this innovative work. His work has resulted in multiple patents related to transplantation technology.

“Dr. Cetrulo’s leadership and expertise are tremendous assets to our patients and surgical teams,” said Cristina Ferrone, MD, chair of the Department of Surgery. “He is a world-renowned innovator and extremely deserving of this recognition. His impactful research will continue to drive innovation in medicine.”

After earning his bachelor’s degree at Stanford University, Cetrulo earned his medical degree from Tufts University School of Medicine in Boston. He completed a general surgery residency at Lahey Clinic Medical Center, followed by a plastic surgery residency at Long Island Plastic Surgical Group/Nassau County Medical Center. He also completed fellowships at New York University’s Institute of Reconstructive Plastic Surgery, Craniofacial and Microsurgical Tissue Engineering Research as well as The Buncke Clinic in San Francisco in hand and microsurgery.

Read more from Cedars-Sinai Catalyst: Donor Spotlight—General William and Willa Dean Lyon