TECHNOLOGY DISRUPTORS

Robotics in Plastic Surgery: It’s Here

Dominic Henn, MD1,2
Summary: Although robotic surgery has been routinely established in other
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Artem A. Trotsyuk, PhD1

Janos A. Barrera, MD1 surgical disciplines, robotic technologies have been less readily adopted in
plastic surgery. Despite a strong demand for innovation and cutting-edge
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Dharshan Sivaraj, BS1

Kellen Chen, PhD1,3
Smiti Mittal, BS1
Alana M. Mermin-Bunnell, BS1
Arhana Chattopadhyay, MD1
Madelyn R. Larson, BS1
Brian M. Kinney, MD4
James Nachbar, MD5
Sarvam P. TerKonda, MD6
Sashank Reddy, MD7
Lynn Jeffers, MD, MBA8
Justin M. Sacks, MD, MBA9
Geoffrey C. Gurtner, MD1,3
Stanford, Beverly Hills, and Oxnard,
CA; Dallas, TX; Tucson and
Scottsdale, AZ; Jacksonville, FL;
Baltimore, MD; and St. Louis, MO
technology in plastic surgery, most reconstructive procedures, including
microsurgery, have continued to necessitate an open approach. Recent
advances in robotics and artificial intelligence, however, are gaining momen-
tum and have shown significant promise to improve patient care in plastic
surgery. These next-generation surgical robots have the potential to enable
surgeons to perform complex procedures with greater precision, flex-
ibility, and control than previously possible with conventional techniques.
Successful integration of robotic technologies into clinical practice in plastic
surgery requires achieving key milestones, including implementing appro-
priate surgical education and garnering patient trust. (Plast. Reconstr. Surg.
152: 239, 2023.)

A
dvanced surgical robotics represent the
merger of surgical technique with sophis-
ticated and intelligent technology. Novel
robotic technologies provide users with enhanced
precision, a greater degree of freedom in move-
ment, improved visual–spatial resolution, and
tremor elimination while operating. Having the
potential to confer dramatic improvements in
functional, aesthetic, and quality-of-life outcomes
for patients, these innovations will expand the
breadth of operations that surgeons are able to
perform safely.
From the 1Hagey Laboratory for Pediatric Regenerative
Medicine, Division of Plastic and Reconstructive Surgery,
Department of Surgery, Stanford University; 2Department of
Plastic Surgery, University of Texas Southwestern Medical
Center; 3Department of Surgery, University of Arizona; 4pri-
vate practice; 5Scottsdate Plastic Surgery LLC; 6Division
of Plastic Surgery, Department of Surgery, Mayo Clinic;
7
Department of Plastic and Reconstructive Surgery, Johns
Hopkins University; 8St. John’s Pleasant Valley Hospital;
9
Division of Plastic and Reconstructive Surgery, Department
of Surgery, Washington University in St. Louis School of
Medicine.
Received for publication December 26, 2021; accepted
October 20, 2022.
The first two authors contributed equally.
Copyright © 2023 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000010270
The Automated Endoscopic System for
Optimal Positioning (AESOP) robot, developed
by Computer Motion, Inc., was the first surgical
robot to gain U.S. Food and Drug Administration
(FDA) approval, in 1994.1 The system was
designed to manipulate a laparoscopic surgical
camera and possessed optical arms with seven
degrees of freedom.2 This robot was ultimately
modified and renamed the Zeus Robotic Surgical
System (ZEUS), which included a separate oper-
ating console for the surgeon to sit comfortably
during the operation. ZEUS was used for the
first transcontinental robot-assisted laparoscopic
cholecystectomy, famously known as “Operation
Lindbergh.”3
Today, the most popular robotic platform
is the da Vinci surgical system, developed by
Intuitive Surgical, Inc. (Sunnyvale, CA), and
approved by the FDA in 2000 (Fig. 1). The da
Vinci system is the market leader, with more than
5 million reported surgical interventions across
Disclosure statements are at the end of this article,
following the correspondence information.
Related digital media are available in the full-text
version of the article on www.PRSJournal.com.

www.PRSJournal.com 239
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 Plastic and Reconstructive Surgery • July 2023
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Fig. 1. (Above, left) Intraoperative use of the da Vinci surgical system. (Above, right) Surgeon remotely operating the da Vinci system
from the console. (Below, left) MUSA microsurgery robot (Microsure). (Below, right) Intraoperative use of the MUSA microsurgery
robot in a hand surgery case. Images used with permission from Intuitive Surgical, Inc., and Microsure.

the United States and 65 other countries. The
platform consists of three components: a sur-
geon’s console; a patient trolley, which has mul-
tiple articulating robotic arms; and an imaging
system capable of generating real-time three-
dimensional images.4 This system has undergone
several modifications over the years to improve
ease of handling, increase the range of instru-
ment movements, and enhance image resolu-
tion, leading to widespread adoption in many
disciplines, such as urology, gynecology, cardiac
surgery, and general surgery.5
CURRENT APPLICATIONS OF ROBOTIC
SURGERY
The introduction of robotic surgery into sur-
gical practice began with procedures addressing
anatomically uniform and easily reachable organs
located at a safe distance from vital structures,
such as transurethral prostate resection beginning
around 1991,6 hysterectomy,7 and hip or knee
replacement.8
In plastic surgery, robotically assisted surgery
has been used for transoral reconstruction of oro-
pharyngeal defects, muscle and perforator flap
harvest, complex ventral hernia repair, and more
recently, microvascular anastomosis.9–11
Transoral robotic surgery was approved by
the FDA in 2009 as a minimally invasive approach
to resect oropharyngeal tumors.12 The recon-
struction of these defects also can be performed
robotically, thus eliminating the need for mandib-
ulotomy and lip-split incision, allowing for a high
degree of precision and visualization within the
oropharynx.13–15 Robotic surgery has the poten-
tial to be applied to other indications in cranio-
facial surgery beyond oncologic reconstruction.
A preclinical study recently reported the develop-
ment of a cleft palate simulator for robotic cleft
palate surgery,16 providing superior visualization,
improved ergonomics, increased dexterity, and

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 Volume 152, Number 1 • Robotics in Plastic Surgery
greater instrument articulation within the intra-
oral space compared with standard instruments.17
Indications for robotic muscle harvest include
free flaps, as well as pedicled flaps for chest wall,
pelvic, and breast reconstruction. Harvesting the
rectus abdominis or latissimus dorsi flaps requires
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extensive skin incisions, which can result in poor
cosmetic outcomes and significant donor-site
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morbidity.18 The da Vinci surgical system can be
used to harvest rectus abdominis flaps without
violating the anterior rectus sheath, thus decreas-
ing incisional morbidity.19,20 Robotic latissimus
dorsi harvest has demonstrated benefits over tra-
ditional open and endoscopic techniques, neces-
sitating only minimal donor-site incisions and
leading to reduced postoperative pain and length
of hospitalization.10,21,22
Early experience with robotic nipple-sparing
mastectomy and implant-based reconstruction
has demonstrated low rates of skin necrosis and
a high degree of patient satisfaction. A transaxil-
lary approach through small incisions also may
improve aesthetic outcomes.23,24 For autologous
breast reconstruction, robotic pedicle dissection
of the deep inferior epigastric perforator flap can
be performed using a transabdominal approach
from the posterior surface of the abdominal wall,
thus reducing the length of the fascial incision of
the anterior rectus sheath.9,25,26
Robotic surgery has allowed for improved
visualization, precision, and flexibility in com-
plex ventral hernia repairs compared with stan-
dard laparoscopic approaches.27 Robot-assisted
transabdominal preperitoneal surgery for large
ventral hernias allows for a dissection in three-
dimensional space and minimally invasive mesh
placement.28
Robotic applications in microsurgery have the
potential to revolutionize a field in which a high
degree of precision is critical for successful post-
operative outcomes.29 Several companies, such
as Microsure (Eindhoven, Netherlands) (Fig. 1)
and Medical MicroInstruments, Inc. (Calci, Italy),
have developed robots specifically created for
microsurgical applications.30 These new systems
may be particularly useful for supermicrosur-
gery such as lymphovenous and perforator-to-
perforator anastomoses.30 Robotic surgery offers
important advantages, such as motion scaling for
tremor elimination and enhanced precision and
stability during complex microvascular anastomo-
sis. Van Mulken et al.31 recently demonstrated a
significantly shorter operative time in a case series
of lymphovenous anastomosis for the treatment
of breast cancer–related lymphedema using the
Copyright © 2023 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
MUSA robot (Microsure) compared with conven-
tional anastomosis.
Dobbs et al.4 performed a systematic review
on the use of robotics in plastic surgery in
2017. In Tables, Supplemental Digital Content
1 through 3, we provide an updated overview
of studies using robotic technologies published
between January of 2018 and March of 2022.
The MEDLINE and PubMed Central databases
were queried. The Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA)
flow diagram in Figure 2 summarizes our search
strategy using Medical Subject Heading (MeSH)
terms.32 Identified studies were imported into
EndNote X9 (Clarivate Analytics), and duplicates
were removed. Records were then uploaded to
the Covidence platform (www.covidence.org) for
screening by two independent reviewers (D.H.
and S.M.) using inclusion and exclusion crite-
ria (Fig. 2). (See Table, Supplemental Digital
Content 1, which shows studies on breast surgery
using robotic technologies published between
January of 2018 and March of 2022, http://links.
lww.com/PRS/F932. See Table, Supplemental
Digital Content 2, which shows studies on cra-
niofacial surgery/head and neck reconstruction
using robotic technologies published between
January of 2018 and March of 2022, http://links.
lww.com/PRS/F933. See Table, Supplemental
Digital Content 3, which shows studies on recon-
structive/flap surgery using robotic technologies
published between January of 2018 and March of
2022, http://links.lww.com/PRS/F934.)
IDENTIFIED NEEDS FOR ARTIFICIAL
INTELLIGENCE ROBOTS IN PLASTIC
SURGERY
Although multiple indications for robotics in
plastic surgery have been described, the adoption
of robotic technology into clinical practice has
been slow and is limited to some highly special-
ized centers.10 Because most procedures in plastic
surgery involve surface anatomy and traditionally
rely on open surgical approaches, the benefits of
robotically assisted surgery might not be immedi-
ately evident to surgeons.
Another obstacle to routine implementation
of robotics into clinical practice in plastic sur-
gery is the high cost of the existing systems on
the market, which can exceed $2 million for the
robot and $2000 to $6000 in consumables per 10
procedures. The Microsure robotic system, for
example, is in the same price bracket as many
high-end microscopes, ranging between $400,000
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Fig. 2. PRISMA flow diagram showing the search strategy and process for article retrieval and screening. MEDLINE and PubMed
Central databases were queried for studies on robotic technology in plastic surgery between January of 2019 and March of 2022.

and $650,000 for a fully loaded microsurgery
robot and $3000 and $4000 in consumables.33 A
robot with Medical MicroInstrument’s Complete
Symani System developed for microsurgery pro-
cedures costs $1.06 million and $4000 to $5000
in consumables.34 A more well-known system, the
da Vinci XI robot, costs ≈$2 million, with $3000
to $6000 in consumables.35 Initial upfront costs
offer a deterrence to some health care systems to
adopt robotic procedures into practice, even with
stated patient benefits to microscopic robotic
surgery. CPT codes and diagnosis-related groups
do not reflect the use of robotics and therefore
are coded as standard laparoscopic approaches.
The concern for inadequate reimbursement may
prevent surgeons and hospital administrations
from engaging in robot-assisted surgery, because
the benefits of cost reduction attributable to
reduced operative times or duration of hospital
stay associated with robotic surgery cannot be
immediately anticipated.10,36 Further obstacles
to widespread adoption of currently available
robotic platforms are the small range of appropri-
ate surgical instruments for robotic microsurgery
and the lack of a structured robotic training cur-
riculum for plastic surgeons.10,36 To improve sur-
gical education in robotics during plastic surgery
residency and fellowship training, standardized
assessment tools have been tested and validated.37
Novel robotic platforms, such as the Versius
system (CMR Medical, Cambdridge, United
Kingdom), which recently received CE approval
in the European Union and is being used clini-
cally in India, are addressing some of these limi-
tations by pursuing alternative strategies such
as operating with a system as a service business
model instead of a fixed high price to purchase
the device and consumables, reducing the cost of

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 Volume 152, Number 1 • Robotics in Plastic Surgery
the lifetime operation of a robot for a hospital by
30% to 40%.38 This payment model would reduce
overall robot and consumable costs from $8 mil-
lion to ~$6 million and may be prudent and more
readily adopted by hospitals and clinics as it will
mitigate substantial long-term costs for robotic
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surgery systems. The continuous improvement of
robotic technologies and introduction of artificial
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intelligence (AI) have the potential to overcome
the obstacles of robotics in clinical practice by
making technology more user-friendly and allow-
ing for more competitive pricing because of stan-
dardized production pipelines.
APPLICATIONS OF AI ROBOTS
Principles of AI
The use of AI within robotics is defined as a
concept of self-improving algorithms that enable
machines to recognize objects or words and orga-
nize them into actionable patterns, which are
then utilized to solve problems or make deci-
sions.39 The core feature of AI-driven software is
machine learning, that is, the incorporation of
algorithms whose performance improves as they
are exposed to more data over time.40 Machine
learning is divided into two fields: supervised and
unsupervised learning. The difference between
the two types of learning is that supervised learn-
ing is performed using a ground truth. A ground
truth refers to previous knowledge about the cor-
rect output value that is expected from an algo-
rithm performing a certain computational task.41
Common supervised learning algorithms
include logistic regression, support vector
machines, naïve Bayes, and random forests, which
are applied to a dataset to “learn” the correct
label.41 Once a model is able to learn differences
among data entities (eg, images, using such vari-
ables as pixels, shapes, and color), the perfor-
mance of the model can be evaluated on a test
dataset (data to which the algorithm has not been
exposed), allowing the operator to observe how
well the “trained model” performs at accurately
classifying the data.41
The term “neural networks” recently has
gained traction in supervised learning.42,43 These
algorithms learn by receiving input from many
labeled examples and decouple each example to
understand its underlying features.43 By decon-
structing an input, the neural network is able to
reconstruct it with a correct output. To achieve
greater neural network accuracy, a large num-
ber of diverse training examples are needed.43,44
Copyright © 2023 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Some common applications of neural networks
include image or pattern recognition, self-
driving vehicle trajectory prediction, and facial
recognition.44
Unsupervised learning, on the other hand,
does not use labeled training data.44 Instead, the
algorithms try to infer the relationship among the
data based on natural structures present within
the dataset (eg, color, shape). This type of learn-
ing categorizes an unlabeled dataset by identify-
ing underlying undetected patters44 (Fig. 3).
Next-Generation Semiautonomous Robots
In robot-assisted surgery, most platforms are
semiautonomous. The robots are operated by
algorithms that use a form of supervised learn-
ing.45 Engineers train an algorithm on the correct
output task given a certain input, enabling the
robot to become efficient at performing special-
ized tasks without experiencing fatigue or tremor.
Robot-assisted surgery has been refined to provide
surgeons with an immersive virtual experience
that mimics the mechanics of an operative pro-
cedure, providing AI assistance to enhance the
user experience.46 With recent advancements in
machine learning, robot-assisted surgery is mov-
ing toward a revolution that can enhance surgi-
cal environment perception, precision, safety, and
efficiency. Advanced robotic technologies being
developed that incorporate multiple biosensors
as well as AI with a limited degree of autonomy
will likely transform the way surgery is performed
in the future (Fig. 4, above).
Physical touch of tissue traditionally has pro-
vided critical haptic feedback to the surgeon,
information about pathologies, and guidance
about the appropriate amount of force to apply
during a procedure. Robotic surgery interrupts
the physical connection between the surgeon
and the patient and in telerobotic surgery even
between the surgeon and the robot. This poses
challenges that are being addressed by technolog-
ical advancements using AI. Soft-surface robots
with large-area sensor arrays, called “e-skin,” are
being developed, which mimic the mechanical
and haptic features of a surgeon’s hands, provid-
ing spatial resolution and thermal sensitivity.47
Novel e-skin developments go beyond physical
properties of human skin and are able to perform
metabolic biosensing and transmit information
wirelessly to the user interface using Bluetooth
technology.48
A rapidly evolving area that aims to enhance
the human–machine interface is the development
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Fig. 3. Supervised learning algorithms (eg, artificial neural networks) infer a function from a set of labeled training examples (train-
ing dataset), which can then be used to map unknown datasets. By deconstructing an input, supervised algorithms are able to
reconstruct it with a correct output. Unsupervised learning does not use labeled training data; instead, the algorithms try to infer
the relationship among the data based on natural structures present within the dataset (eg, color, shape). This type of learning
categorizes an unlabeled dataset by identifying underlying undetected patterns.

of AI-powered enhanced intraoperative imaging.
Near-infrared cameras incorporated into robotic
systems enable surgeons to perform indocyanine
green fluorescence imaging intraoperatively,49 an
option currently being transformed into three-
dimensional visualization.50 Multiphoton micros-
copy enables the visualization of subcellular
structures, such as muscle-embedded nerve fibers,
without contrast enhancing or labeling.51 Confocal
laser endomicroscopy allows for real-time in vivo
histologic evaluation of tissues on a cellular level,
providing real-time intraoperative cellular-level
magnified images with up to 5 μm resolution.52
Another pathway of technological develop-
ment is driven toward miniaturized devices, such
as the miniature in vivo robot (MIVR; Virtual
Incision, Omaha, NE), whose arms can enter
body cavities through a single incision.53 Catheter-
like continuum robots also have been developed,
which can reach surgical target sites along tor-
tuous anatomic paths.54 Combined mechanical
refinement and miniaturization have generated a
novel class of “microbots” that mimic and extend
the range of endoscopic surgery toward devices
autonomously navigating within body cavities and
vessels, as exemplified for endovascular heart
valve repair.55,56
Semiautonomous platforms currently in clin-
ical use, such as the latest generation of the da
Vinci robot or the Mazor X Spine Assist robot,
employ AI algorithms and feedback sensors; how-
ever, these devices are completely dependent on

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 Volume 152, Number 1 • Robotics in Plastic Surgery
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Fig. 4. (Above) The development of artificially intelligent robots requires machine learning algorithms that integrate
multimodal training datasets. (Below) The development of autonomous surgical robots requires advanced biosensors
(positional, haptic, and optic sensors) that process and integrate data from the patient, the surgical environment, and
surgical tools.

human control. The next generation of surgical
robots will integrate greater amounts of auto-
mation algorithms that could ultimately lead to
autonomous surgical robots57 (Fig. 4, below).
LIMITATIONS
The transition of a robotic device that
depends on a human surgeon’s decisions toward
a fully autonomous artificially intelligent robot
that makes unsupervised final decisions and
irreversible physical actions bears obvious ethi-
cal and legal challenges.58 With regard to the
development and application of AI software in
medicine, the FDA took a major step in April
of 2019 by proposing a regulatory framework
to ensure that safe and effective AI technology
reaches users, including patients and health care
professionals.59
For a patient receiving robot-assisted surgery
under the joint custodianship of a human surgeon
and a robot, accountability for surgical complica-
tions will have to be reassessed with respect to the
physician–robot–patient axis.60 Would blame for
an atypical cut be placed on the surgeon or on
the engineering team who designed the robot?
Who would be held accountable for a technical
malfunction, such as tissue damage caused by
mechanical failure of a robotic cutting tool: the
surgeon for negligence, the clinic for improper
maintenance, or the manufacturer for faulty
design? Legal analyses show that early adopters
of novel robotic techniques are at highest risk of
litigation.61,62 These substantial uncertainties are
an urgent call for authoritative guidelines to be
developed through a multidisciplinary consensus
process,58 which should also scrutinize the modes
of credentialing surgeons for guiding robotic

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interventions. To date, consensus articles on
robotic surgery are scarce and only available for
specific areas.63,64 A shift from “surgical robots”
toward “robotic surgeons” will also have profound
implications for our professional self-understand-
ing, posing new challenges for the education
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and training of surgeons, nurses, and other staff
members.65–69
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In a study by Boys et al.,70 the majority of pro-
spective patients believed that robotic surgery was
safer, faster, less painful, or offered better results,
but fewer than half of the respondents opted
for the robot when they had the choice between
undergoing a conventional versus a robotic inter-
vention for themselves. We should be aware that
the barrier to adoption of autonomous robotic
surgery may well be neither the technology nor
the surgeons’ AI-enhanced skills in the operating
room, but rather the patients’ trust in the new
division of surgical labor. This study highlights the
need to educate not just medical personnel but
also patients about the use of robotic technology
in surgery.
FUTURE DIRECTIONS
Given the current rate of technological
advancement and increasing computational
power, it is possible that surgical automation may
be achieved in our lifetime. Engineers would
need to use thousands of hours of recorded
procedures to train mathematical models with
detailed instructions on implementing a certain
mock procedure. Both supervised and unsu-
pervised learning will have to be implemented
to enable robots to comprehend a scenario and
determine the optimal solution with the highest
success rate using previous training data. These
mathematical models will have to be validated
and rigorously tested to ensure that the robot
is able to perform a given task successfully. The
development of autonomous AI-powered robots
ultimately could provide a range of benefits,
including reduced operative times, increased
access to specialized care, and improved patient
outcomes.
In plastic surgery, autonomous AI robots
would be particularly useful to streamline time-
consuming and highly standardized procedures,
such as dressing changes, wound closures, or skin
grafting. Robots that enable sewing and auto-
matic knot tying on three-dimensional objects
have already been developed and proven to be
efficient in preclinical studies on vascular stent
grafts.42 These technologies indicate a great
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Plastic and Reconstructive Surgery • July 2023
potential for applications in microsurgery and,
once further developed and scaled down, could
enable automated microvascular anastomosis.
Given that microsurgery robots, such as the MUSA
system, have already proven to be clinically effi-
cient to overcome human limitations in supermi-
crosurgery,31 novel AI-driven technologies could
advance the field further and reduce operative
times of microsurgery cases.
AI robots geared specifically toward soft-tis-
sue surgery are already being tested in preclini-
cal studies. Shademan et al.71 have developed
an AI-powered robotic system that uses machine
learning to generate a plan of complex surgical
tasks on deformable tissue and includes an auton-
omous suturing algorithm. Using in vivo porcine
models, this supervised autonomous robot out-
performed clinically established laparoscopic and
robot-assisted approaches performed by expert
surgeons in terms of operative time, consis-
tency, and accuracy. These findings highlight the
great potential of autonomous surgery robots to
advance clinical outcomes and increase accessibil-
ity to specialized care.
AI robots could make plastic surgery avail-
able in geographic areas or health care systems
with structurally limited access to surgical com-
petence and equipment, such as economically
disadvantaged countries.72 In addition, robotic
technologies could benefit patients in environ-
ments that are difficult to access and routinely
require telemedicine, such as cruise ships, off-
shore platforms, polar expeditions, or even
aboard spacecrafts.73 Another important area
for AI robots would be specialized wound care
during military operations.74 In combat zones,
robotic surgical devices could be operated by
remote steering and prevent surgeons and other
medical personnel from encountering danger.75
Robotic technologies would be particularly ben-
eficial during viral outbreaks, as has been shown
with the use of conventional robots during the
COVID-19 pandemic.76
The implementation of AI robots into clini-
cal practice likely will advance many areas in
plastic surgery, but with some caveats. Complex
technical equipment requires proper surveil-
lance and maintenance, which poses new chal-
lenges to the application of high-tech medicine
in environments without a developed technolog-
ical infrastructure.77 AI robots that act autono-
mously will require careful human supervision,
ensuring that all important clinical information
is captured and handled correctly, and that com-
plications are adequately addressed. Supervision
 Volume 152, Number 1 • Robotics in Plastic Surgery
of robotic technology will be crucial to ensur-
ing patient safety. The main goal of advanced
robotic surgery should be the improvement of
clinical outcomes rather than a reduction of hos-
pital personnel.
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CALL FOR INNOVATION
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The implementation of AI into surgical robot-
ics has already demonstrated that robotic technol-
ogies are able to outperform human surgeons in
terms of efficiency and precision. As a field that
is on the edge of technological advancement,
plastic surgery will benefit greatly from advanced
robotic technologies, which could streamline
operative workflows, decrease operative time,
exceed human manual skills in microsurgery,
and increase access to specialized surgical care
in underserved areas. To overcome the legal and
ethical challenges associated with a transition
from robot-assisted surgery toward autonomous
AI robots, new guidelines and regulatory frame-
works will be required. With the current rate of
technological advancements, the development
of autonomous surgical robots will likely be seen
in our lifetime. By identifying and addressing
potential bottlenecks early, plastic surgeons will
be well-equipped to help guide this AI transition
in a direction of improved clinical outcomes and
enhanced patient care.
Geoffrey C. Gurtner, MD
Department of Surgery
Division of Plastic and Reconstructive Surgery
Stanford University School of Medicine
257 Campus Drive West
Hagey Building GK-201
Stanford, CA 94305-5148
ggurtner@stanford.edu
FAST FACTS
• Robot-assisted surgery has been used for
head and neck reconstruction, flap har-
vest, ventral hernia repair, and (super)
microsurgery.
• Compared with other specialties, the adop-
tion of robotic technology into clinical prac-
tice in plastic surgery has been slow and is
still limited to highly specialized centers.
• The implementation of AI into surgical
robotics has demonstrated higher efficiency
and precision compared with human sur-
geons, showing great promise to improve
patient care in plastic surgery.
Copyright © 2023 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
• 
A transition from robot-assisted surgery
toward autonomous AI robots will be asso-
ciated with legal and ethical challenges
requiring new guidelines and regulatory
frameworks.
DISCLOSURE
None of the authors has a financial interest in any
of the products, devices, or drugs mentioned in this arti-
cle. The funding of this study was solely institutional.
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