Robotic-assisted techniques in complex hand and upper extremity reconstruction: Current capabilities, outcomes, and future opportunities

Complex hand and upper extremity reconstruction is undergoing revolution with robotic-assisted methods that restore dexterity impaired by stroke and injury or neurological diseases that affect the quality of life. More sophisticated technologies, such as exoskeletons (e.g., Armin), end-effecter devices (e.g., Rego), and microsurgical robots (e.g., Da Vinci), allow for accurate operation and extensive therapy to be carried out. The clinical outcomes (2015 and 2025) are characterized by substantial improvements in motor function and dexterity, with a 2.6 to 3.4-point increase in the Fugl-Meyer Assessment, compared to a 2.0 to 2.9-point improvement in control patients (p < 0.05). These technologies enhance patient interaction by utilizing virtual reality and gamification, resulting in a 10- to 15-point improvement on the Barthel Index and a 60% decrease in depression. Nonetheless, prohibitive costs ($50,000-$1,250,000/system), training requirements, and the scarcity of long-term data are significant challenges. New technologies, such as AI-powered personalization, brain-computer interfaces, and mobile robotics, hold the potential for easily available, customized opportunities. New horizons exist to expand the treatment of children with conditions and non-stroke injuries. Robotic-assisted methods have the potential to transform reconstruction outcomes by breaking down barriers such as cost and training, thereby combining the precision of high-precision surgery with the intensity of high-intensity therapy to enhance the reconstruction process. The article discusses such advancements and their future potential to change the way patients are cared for in the field of hand and upper extremity reconstruction.