Decoding the Impact of AI on Microsurgery: Systematic Review and Classification of Six Subdomains for Future Development.

Background: The advent of artificial intelligence (AI) in microsurgery has tremendous potential in plastic and reconstructive surgery, with possibilities to elevate surgical precision, planning, and patient outcomes. This systematic review seeks to summarize available studies on the implementation of AI in microsurgery and classify these into subdomains where AI can revolutionize our field. Methods: Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meticulous search strategy was used across multiple databases. The inclusion criteria encompassed articles that explicitly discussed AI's integration in microsurgical practices. Our aim was to analyze and classify these studies across subdomains for future development. Results: The search yielded 2377 articles, with 571 abstracts eligible for screening. After shortlisting and reviewing 86 full-text articles, 29 studies met inclusion criteria. Detailed analysis led to the classification of 6 subdomains within AI applications in microsurgery, including information and knowledge delivery, microsurgical skills training, preoperative planning, intraoperative navigational aids and automated surgical tool control, flap monitoring, and postoperative predictive analytics for patient outcomes. Each subtheme showcased the multifaceted impact of AI on enhancing microsurgical procedures, from preoperative planning to postoperative recovery. Conclusions: The integration of AI into microsurgery signals a new dawn of surgical innovation, albeit with the caution warranted by its nascent stage and application diversity. The authors present a systematic review and 6 clear subdomains across which AI will likely play a role within microsurgery. Continuous research, ethical diligence, and cross-disciplinary cooperation is necessary for its successful integration within our specialty.