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News — LOS ANGELES (March 10, 2025) -- Last October, the night before Deven Phillips was to undergo her second lymphatic surgery, she received an unexpected call from her surgeon.

"He casually asked me, ‘Deven, what do you think about a robot doing your surgery?’” Phillips said. “I asked if he was going to be in the room. He said, ‘Of course, I will be there.’”

That was reassuring enough for her to go ahead with the robot-assisted surgery, making Phillips, an elementary school teacher in Rancho Cucamonga, the first patient at Cedars-Sinai to undergo the robot-assisted microsurgery for lymphovenous bypass. It’s a minimally invasive procedure involving rerouting blocked blood vessels using sutures—some thinner than the diameter of a human hair—to alleviate fluid buildup and improve drainage for people with lymphedema.

Lymphedema causes painful swelling due to lymphatic fluid buildup, and can result from cancer treatments, such as chemotherapy, radiation and lymph node removal. Phillips developed the condition in her arms after undergoing extensive breast cancer treatments following her 2017 diagnosis.

The surgical team was led by , a plastic surgeon in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai and program director of the  program, who utilized the Symani Surgical System. The robotic platform, Brazio said, significantly improves the precision and control necessary to carry out the delicate and complex surgery.

“It translates my movements into smaller movements,” he said. “The robot helps filter out tremors that everyone has to some degree. The key to operating on such small vessels is working with that precision.”

Handling the robot, according to Brazio, is akin to playing a virtual reality video game. In the operating room, the surgeon wears 3D goggles and manipulates chopstick-like hand instruments while viewing a magnified screen that highlights the minuscule lymphatic vessels. The robot executes the surgeon’s precise maneuvers on the patient, potentially minimizing scarring and vessel damage.

“Ergonomically, it’s a huge advantage,” Brazio said. “We’re able to sit up straight instead of leaning over sideways or operating at awkward angles, which reduces fatigue and increases surgical accuracy.”

Cedars-Sinai is the first program in the western United States to offer microsurgical robotic capabilities. The platform 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  to remove tumors from hard-to-reach areas.

Though Phillips had undergone a previous lymphatic surgery and relied on traditional treatments like compression garments and physical therapy, she had been living with the debilitating effects of lymphedema for years. But after undergoing the robot-assisted lymphatic surgery, she was able to bounce back to her routine within days.

Phillips’ recovery aligns with what , vice chair of Research in the  and director of the Division of Plastic Surgery at Cedars-Sinai, envisioned.  

“Due to the greater levels of precision the robotic platform lends, it enables us to treat more lymphatic pathways, potentially improving lymphatic drainage, providing symptom relief,” Cetrulo said. “Through the use of the robot-assisted technology, we’re building a team of highly skilled surgeons, and our Complex Reconstruction and Microsurgery Fellowship program is one of the first in the nation to train fellows in robotic-assisted microsurgical technique.”

Cetrulo added that Cedars-Sinai—being one of the first institutions in the country to adopt innovative robot-assisted procedures—is paving the way to potentially broaden access to life-changing treatments that significantly improve quality of life for patients like Phillips.

“I’m looking forward to getting back into the gym, lifting weights and getting back to where I want to be,” she said. “Most importantly, I would love to be able to wear my wedding ring again.”

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