The Symani robot allows for millimetre-precise surgery on blood vessels, nerves and lymphatic ducts to perform complex reconstructions, repair lesions and treat conditions such as lymphoedema or oncological sequelae.
The Plastic Surgery and Orthopaedic Surgery and Traumatology services will be the first to use the new microsurgery and supermicrosurgery robot.
The Bellvitge Hospital has a sixth surgical robot as of today. It is the Symani, the first robotic platform designed specifically for open surgery and, in particular, for microsurgery and supermicrosurgery. In the coming days, the first procedures with the new robot will be carried out in the Plastic Surgery and Traumatology departments.
With the addition of Symani, Hospital de Bellvitge consolidates its national leadership in robotic surgery. The robot for microsurgeries and supermicrosurgeries joins the four Da Vinci robots (one of which, the Da Vinci SP, is designed for single-port surgery, and the Versius robot, with a modular design that makes it easy to move).
HUB is the hospital that performs the most robotic procedures annually in the country. In 2025, the HUB performed around 1,200 procedures, a figure it expects to increase to 1,600 by the end of 2026 and to nearly 2,000 in 2027.
Microsurgery is a surgical speciality that operates on very small anatomical structures — blood vessels, nerves and lymphatic ducts — using microscopes and instruments of extreme precision. It allows tissues and organs to be repaired or reconstructed in cases of cancer, trauma or diseases such as lymphedema.
Microsurgery works on structures between 0.8 and 8 mm in diameter, while supermicrosurgery, even more demanding, addresses structures under 0.8 mm, such as lymphatic vessels or capillaries as small as 0.3 mm. The new robot will have immediate applications in a wide range of complex surgical procedures. Among the most notable are the treatment of lymphoedema via lymphatic–venous anastomoses; tissue transplantation to repair injuries caused by accidents, trauma or previous oncological surgeries; and the repair of peripheral nerves. All of these are highly technically complex procedures that will directly benefit from the precision and stability offered by the Symani.
Lymphedema, first surgery with the new robot
The first procedure with the Symani will be surgery for secondary lower-limb lymphedema. Lymphedema is a chronic, progressive condition caused by a disruption of the lymphatic system that leads to fluid accumulation in the tissues, resulting in swelling, heaviness and a significant reduction in the patient's quality of life.
In this case, the lymphedema is secondary, that is, a consequence of a previous injury or treatment—usually oncological—that has damaged or removed the lymph nodes in the area. The technique to be applied consists of lymphatic-venous anastomoses: microsurgical connections between lymphatic vessels and small veins to create an alternative drainage pathway that allows the accumulation of fluid to be reduced.
It is one of the most technically demanding supermicrosurgical procedures, as lymphatic vessels can be less than 0.5 mm in diameter, and it is precisely in this type of operation that the Symani robot offers the greatest added value thanks to its ability to work with absolute precision on sub-millimetre structures.
Remote control to emulate the surgeon's hand movements
With the Symani, the surgeon operates two robotic micro-tubes from a remote console, which are connected to articulated arms that can act on any anatomical region of the body. From the remote station, the surgeon controls the robotic micro-tubes as if they were their usual instruments.
The robotic system registers the surgeon's hand movements in the area of the operation, which are displayed magnified up to 30 times on a screen with the option of a 3D view, and copies them, converting them into identical, but reduced, movements up to 20 times in the micro-instruments incorporated into the robotic arms. In this way, highly complex microsurgeries and supermicrosurgeries can be performed with complete precision and safety on anatomical structures such as blood vessels, nerves or lymphatic vessels, with a diameter that sometimes does not exceed 0.3 mm.
In the opinion of Dr Anna López-Ojeda, Head of the Plastic and Reconstructive Surgery Department at Bellvitge Hospital, the introduction of the Symani "represents a qualitative leap in our ability to perform microsurgery and supermicrosurgery with the utmost precision. Thanks to this robot, we will be able to offer our patients procedures that until now were technically very demanding, such as lymphatic anastomoses in the treatment of lymphedema, with results that are more difficult to achieve manually. The Symani eliminates the surgeon's physiological tremor and scales the movements to a sub-millimetre precision, which opens the door to a new era in reconstructive surgery."
For its part, its first applications in the Orthopaedic Surgery and Traumatology Service will allow for more precise addressing of nerve transfers and hyper-selective neurectomies and neurotomy in the treatment of spasticity, procedures that require working on nerve structures with a very small diameter. The robot will make these interventions safer and more consistent, as explains Dr Silvia López Marne, Clinical Head of the Orthopaedic Surgery and Traumatology Service.