Robotic microsurgery offers new hope for lymphedema patients at USF Health and Tampa General Hospital

After nearly two decades of living with lymphedema, Army veteran Monica Boney had built her life around managing the constant swelling, pressure and care required to get through each day.

What began with a spider bite while she was deployed to Afghanistan in 2001 ultimately led her to USF Health and Tampa General Hospital, where she found a breakthrough surgical approach that is changing what's possible for patients like her.

Dr. Nicholas Panetta, chair of the USF Health Morsani College of Medicine Department of Plastic Surgery and chief of the Plastic Surgery Institute at TGH, is among the small group of surgeons worldwide trained to use a highly specialized robotic platform known as the Symani Surgical System to perform microscopic procedures that restore lymphatic drainage.

The technology is opening a new chapter for patients who once had few options.

Affecting 10 million Americans, lymphedema is a chronic and often misunderstood condition marked by painful swelling in the arms or legs when the lymphatic system is disrupted. This system normally drains fluid and supports immune function, but when damaged, it can lead to fluid buildup, swelling and other complications.

"Think of it as a plumbing problem," Panetta explained. "Fluid keeps coming into the arm or leg, but because the normal drainage pathways have been disrupted, it can't get out."

The condition can have a profound and disruptive impact on daily life. Patients often rely on tight compression garments, undergo specialized massage therapy or use pumps to move fluid out of the limb. In severe cases, infections can lead to hospitalization.

"Managing lymphedema can dominate your entire existence," Panetta said. "Patients deal with wrapping, compression garments, therapy appointments, massage and pumps."

For decades, treatment focused on managing symptoms rather than fixing the underlying problem that worsens over time. That is now changing through microsurgery.

Using a technique called lymphatic-venous bypass, surgeons connect tiny lymphatic vessels directly to nearby veins, creating a new pathway for fluid to drain.

The challenge is scale: These vessels are often less than a millimeter wide - about the size of a sharpened pencil tip. Operating on structures that small requires extraordinary precision.

The Symani Surgical System dramatically enhances precision by eliminating a surgeon's natural hand tremor - stabilizing movements that were previously impossible to achieve.

USF Health and TGH acquired this rare technology from Medical Microinstruments during Gov. Ron DeSantis's trade mission to Italy in 2024. It's already leading to life-changing outcomes for patients in Tampa Bay - including Boney, who now resides in Riverview.

In 2001, Boney, a former college basketball player who served during Operation Enduring Freedom, was bitten by a camel spider while deployed in Afghanistan. The resulting infection severely damaged her lymphatic system, leaving her with stage-two lymphedema in her leg.

Over the next two decades, the condition reshaped her daily life. Walking, prolonged standing, traveling and even finding clothes that fit became difficult. Managing symptoms with pumps and therapies required nearly 90 minutes each day, and the constant pressure in her leg often kept her awake at night. Eventually, it forced her to step away from her military career.

After moving to Florida, Boney was referred to TGH and Panetta, who evaluated her for microsurgical reconstruction. Using advanced imaging and robotic assistance, his team identified viable lymphatic channels and performed a delicate procedure to restore drainage.

The procedure involved only tiny incisions - about a centimeter long - and her recovery was swift. Within weeks, Boney returned to an active lifestyle. Just 30 days after surgery, she completed a 75-mile cycling event supporting the Wounded Warrior Project.

"It was the most painless surgery I ever had in my life - I didn't even need to take Tylenol," Boney said. "It was a six-hour procedure, and I got up and walked right after."

After the breakthrough surgery, Boney continues to enjoy her significantly improved quality of life. Though she still wears compression stockings daily, she swims, power walks and stays active with fewer limitations.

"If sharing my story helps even one person seek treatment sooner," she said, "then every step of this journey has been worth it."

Panetta believes robotic microsurgery is helping expand access to procedures that were once limited to a small number of highly specialized surgeons. By improving precision and reproducibility, advanced technologies like the Symani system at TGH and USF may help train more surgeons and bring advanced care to more patients.

"For a long time, patients were simply told that lymphedema was something they had to live with," he said. "But we now have the ability to intervene and change the course of the disease."