Tim Tai

Yale New Haven Hospital is the first hospital in New England to use a robot that helps surgeons perform delicate procedures on blood vessels and tissues smaller than a grain of rice.

On March 18, YNHH announced it had begun using the Symani Surgical System, a robotic platform designed to enhance precision during microsurgery and supermicrosurgery — procedures that involve connecting tiny blood vessels and lymphatic channels. YNHH is currently one of only five hospitals in the United States using the technology. Hospital leaders say the system may improve outcomes and reduce recovery time for patients undergoing breast reconstruction, lymphatic repair and trauma-related surgery.

The Symani system works by translating a surgeon’s hand movements into smaller, more controlled motions, reducing the margin of error in procedures where accuracy is essential. The robot’s design allows it to handle sutures and vessels that are less than one millimeter wide, which are difficult to work with using the human hand alone. While its current use is in breast and lymphatic surgery, the technology may eventually be applied to areas such as head and neck cancer reconstruction, ear surgery and organ transplants.

“It allows the surgeon to make a large movement, which translates by the robot into a microscopic movement,” said Dr. Bohdan Pomahac, chief of Plastic and Reconstructive Surgery at YNHH. “Any precision manipulations are going to be greatly helped with the aid of the robot.”

This can have real benefits for patient recovery. 

For example, in breast reconstruction using a patient’s own abdominal tissue, the robot allows surgeons to connect smaller vessels closer to the skin’s surface. That means they no longer need to make larger incisions through muscle and fascia — the layers of tissue covering the muscles — reducing pain and healing time. According to Pomahac, patients who previously needed several inches of dissection may now require only two or three.

“This will greatly enhance care for patients affected by trauma, cancer, congenital malformations and lymphedema,” said Dr. Nita Ahuja, chief of Surgery at YNHH and chair of Surgery at the Yale School of Medicine.

The Symani robot may also accelerate surgical training. Pomahac said that studies have shown novice users to perform surgical tasks with the robot at expert levels after only five to seven practice sessions. In contrast, traditional microsurgery techniques often require years of training and experience to master.

Training on the Symani system includes two days of instruction in a simulated environment, followed by supervised clinical use. At YNHH, only surgeons with prior microsurgical experience are currently approved to operate the robot. The system itself is mobile and can be brought into the operating room without major changes to equipment or setup.

The hospital is also the lead site for a nationwide clinical trial evaluating outcomes of surgeries performed using the robot. The trial, which includes four other hospitals and may expand to eight to 12 sites, will gather data on breast reconstruction, lymphatic procedures and head and neck reconstruction.

“We are very excited to join the very small group of hospitals in the U.S. and across the world using this robot to treat the most challenging patient conditions,” said Dr. Katherine Heilpern, president of YNHH.

The Symani system was developed by Medical Microinstruments, or MMI, a company focused on improving outcomes in soft tissue surgery. 

Pomahac said his relationship with the company, which began during his time at Harvard Medical School, played a role in bringing the robot to Yale. He currently serves as the lead investigator for the clinical trials assessing the system’s performance.

He added that YNHH’s leadership was receptive to adopting the technology and supported the acquisition. According to Pomahac, the company is now working on new tools to expand the system’s capabilities, including energy instruments and fine dissection tools, which could enable broader use in transplant, brain and gynecologic surgery.

Pomahac said the broader field of robotic surgery continues to grow. In other specialties, robots are already used to guide orthopedic implants or assist with abdominal surgery. The Symani system, however, is one of the first designed specifically for soft tissue microsurgery. Unlike most surgical robots, it does not require a physical connection between the surgeon and the robotic arm, and operates through a video console, making setup quicker and easier.

“Robots are the future,” Pomahac said. “I think technology will reduce surgeon error and help standardize operations in a way that improves consistency and outcomes.”

YNHH is located at 20 York St.