Simplifying Lymphatic Care With the MMI Symani® Surgical System

Dr. Klein explains, “It’s brand-new to the U.S. Symani® is a robotic surgical system that specializes in microsurgery, surgery of small structures and microsurgery, which are structures less than 1 millimeter in size. It’s the only FDA-approved robot in the U.S for microsurgery and supermicrosurgery.”

“This new technology allows us to do a few amazing things. In the world of lymphatic surgery and medicine, my area of specialty, the lymphatic system is very small. The vessels are all sub-1-millimeter. It's always been a challenge to do surgery on those small structures. We still rely on our human hands to sew these structures together, especially a vessel size of 2 millimeters, with sutures thinner than a human hair,” Dr. Klein shares.

He continues, "The Symani® allows us to operate routinely and with ease. The robot removes the natural tremor that occurs in every human hand and allows the surgeon to move the needle in areas your wrist alone can’t reach. Because the instrument’s tip is located where the wrist is, you can move it in positions that weren’t humanly possible with standard surgical equipment.”

“For regular microsurgery, called free-flap surgery, which we do routinely, with this device, we can reach difficult areas and increase precision because of enhanced magnification, and again, ruling out the natural tremor, increasing the surgeon’s longevity at the job rather than being contorted around the patient.”

Dr. Klein states, “The MMI Symani® Surgical System is currently FDA-approved for lymphatic surgery for adults, reconstructive surgery for tissue transfers, as well as head and neck surgery. The applications will be vast, applicable to neurosurgery, neurology and any type of surgery that requires access to minuscule spaces. The Symani® difference is that it's designed for deep open wounds rather than large cavities.”

“Anyone who is a candidate for lymphatic surgery in general is a candidate for robotic lymphatic surgery — including lymph node transfers, vascularized lymph node transfer, lymphovenous bypass to treat lymphedema and to prevent the formation of lymphedema with a lymph node dissection,” says Dr. Klein.

Dr. Klein emphasizes, “Robotic surgery increases precision, leads to greater outcomes, and it also allows us to perform procedures that couldn’t be performed before because of the limitations of the human body. This leading-edge technology allows us to perform complex surgeries with ease.”

“Recovery is probably going to be about the same, maybe slightly quicker than traditional techniques, because the incisions don't have to be as big in certain situations, leading to a quicker recovery. I expect to see improvements quicker than with an open surgery technique,” Dr. Klein explains.

Dr. Klein shares, “It’s not much different than what we normally do with other techniques. Patients don’t have to do anything differently, so nothing changes in that sense.”

Dr. Klein enthusiastically shares, “It’s going to be a game-changer for a lot of people. There are lymphatics in the brain, called glymphatics. You can think of the glymphatic system as a waste clearance pathway in the brain. It uses cerebrospinal fluid to wash away toxic proteins and cellular waste. This network is most active during deep sleep, helping keep the central nervous system healthy.

From data coming out of China within the past two years, there appears to be an association with blockage of the lymphatic system in the brain with the development of dementia. The Chinese have been doing lymphovenous bypasses in the neck. Data from performing lymphovenous bypasses in the neck, draining the waste, show an improvement in the symptoms of dementia that is almost immediate.” To mirror that data, MMI is sponsoring several clinical trials in the United States, including one called REMIND, in which we're looking at Brain Lymphatics and improvements in dementia after the lymphovenous bypass. The first few patients were enrolled in a pre-trial at three sites around the country, including Jacksonville, Florida, and those cases showed improvements in patients' symptoms. The goal is to find connections between draining the brain's lymphatics and treating dementia symptoms.

The second trial, called PRECISE, is studying outcomes of microsurgery vs. older traditional surgical techniques.

Dr. Klein offers, “You would want to go and find someone who offers this type of surgery, especially with lymphatic work, because you’ll be assured your doctor has better insights and capabilities because of the precision.”

“At AdventHealth, we’ve performed the largest number of cases and treated more patients in a month using the Symani® Robot than anywhere else in the world. This is an exciting time in the world of lymphatics,” Dr. Klein shares.