Nerve Transfers Using a Dedicated Microsurgical Robotic System

Plastic & Reconstructive Surgery Global Open, vol. 11, pp. e5192

Abstract

Microsurgical demands in peripheral nerve surgery are increasing. Because of the development of multiple simultaneous selective nerve transfers, the transposition of very small nerves and even single fascicles has evolved. Coaptation of these increasingly smaller structures require high skills in microsurgical techniques. In addition, the surgical situs often has very limited access and is difficult to reach with conventional microsurgical options. Robot technology, the Symani Surgical System (Medical Microinstruments, S.p.A, Calci, Pisa, Italy), was used for epineural coaptation of three donor nerves (intercostal nerves 4-6) to the long thoracic nerve and the thoracodorsal nerve as recipient nerves in a patient with brachial plexus palsy. The coaptations could be carried out successfully with the microsurgical robot technology. In combination with a high-magnification (up to 26×) 3D-exoscope, the epineural sutures could be placed very precisely and accurately. Using this new microsurgical robotic system, successful coaptation of very small nerve structures is possible. This opens possibilities for the microsurgeon to carry out even finer, more targeted and more complex nerve transfers, including procedures in anatomical regions that are difficult to reach.

Authors 3

1. Benedikt Schäfer Aachen Department of Plastic Surgery Hand Surgery—Burn Center Division for Plexus Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany

   Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany

2. Jörg Bahm Aachen Department of Plastic Surgery Hand Surgery—Burn Center Division for Plexus Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany

   Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany

3. Justus P. Beier Aachen Department of Plastic Surgery Hand Surgery—Burn Center

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany