Robotic Nerve Surgery: Brachial Plexus

Abstract

Management of closed brachial plexus injuries has traditionally favored conservative approaches with lengthy intervals between initial injury and surgical reconstruction. The complex anatomy of this region often requires large incisions with extensive dissection. Recently, the use of robotic systems in plastic and reconstructive surgery has been increasing, and robot-assisted brachial plexus reconstruction is a novel application that is currently being explored. Current literature describing this application is primarily comprised of feasibility studies using animal and cadaver models, and literature describing use in human subjects is limited. Advantages demonstrated by these early studies include the reduction of physiologic tremor, 3D visualization of anatomical structures, and ergonomic positioning; this allows for increased surgical dexterity and the ability to perform minimally invasive microsurgical procedures within the confined anatomical spaces of the brachial plexus. Limitations revolve around inadequate instrumentation, large learning curves, and increased costs that restrict the ability to perform these complex microsurgical procedures reliably and efficiently. As companies continue to develop instrumentation specific to robot-assisted microsurgery, more extensive longitudinal studies outlining long-term costs, changes in operating time, and functional outcomes will be required before a conclusion about the utility of these systems in brachial plexus surgery can be made.

Keywords

plastic surgery - robotic surgery - brachial plexus

Publikationsverlauf

Artikel online veröffentlicht:
18. September 2023

• References

• 1 Facca S, Hendriks S, Mantovani G, Selber JC, Liverneaux P. Robot-assisted surgery of the shoulder girdle and brachial plexus. Semin Plast Surg 2014; 28 (01) 39-44
• 2 Pejkova S, Filipce V, Peev I. et al. Brachial plexus injuries: review of the anatomy and the treatment options. Prilozi (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42 (01) 91-103
• 3 Shin AY, Bishop AT, Loosbroch MF, Spinner RJ. A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years. J Hand Surg Eur Vol 2022; 47 (11) 1103-1113
• 4 Chuang DCC. Adult brachial plexus reconstruction with the level of injury: review and personal experience. Plast Reconstr Surg 2009; 124 (06) e359-e369
• 5 Krishnan KG, Pinzer T, Reber F, Schackert G. Endoscopic exploration of the brachial plexus: technique and topographic anatomy: a study in fresh human cadavers. Neurosurgery 2004; 54 (02) 401-408 , discussion 408–409
• 6 Braga-Silva J, Gehlen D, Kuyven CRM. Endoscopic exploration of a brachial plexus injury. J Reconstr Microsurg 2006; 22 (07) 539-541
• 7 Rasulic L. Current concept in adult peripheral nerve and brachial plexus surgery. J Brachial Plex Peripher Nerve Inj 2017; 12 (01) e7-e14
• 8 Nectoux E, Taleb C, Liverneaux P. Nerve repair in telemicrosurgery: an experimental study. J Reconstr Microsurg 2009; 25 (04) 261-265
• 9 Garcia Jr JC, Lebailly F, Mantovani G, Mendonca LA, Garcia J, Liverneaux P. Telerobotic manipulation of the brachial plexus. J Reconstr Microsurg 2012; 28 (07) 491-494
• 10 Tan YPA, Liverneaux P, Wong JKF. Current limitations of surgical robotics in reconstructive plastic microsurgery. Front Surg 2018; 5: 22
• 11 Dobbs TD, Cundy O, Samarendra H, Khan K, Whitaker IS. A systematic review of the role of robotics in plastic and reconstructive surgery: from inception to the future. Front Surg 2017; 4: 66
• 12 Robotti E, Longhi P, Verna G, Bocchiotti G. Brachial plexus surgery. An historical perspective. Hand Clin 1995; 11 (04) 517-533
• 13 Galenus C. Omnia Quae Extant Opera in Latinum Conversa, Ed VIII. Venice: Giunta; 1609
• 14 Injuries of nerves and their consequences. Digital Collections: National Library of Medicine. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-66230920R-bk
• 15 Gilbert A, Pivato G. Obstetrical palsy: the French contribution. Semin Plast Surg 2005; 19 (01) 5-16
• 16 Diseases of the Peripheral Nerves 1Cyclopædia of the Practice of Medicine. Edited by Dr. H. von Ziemssen. Vol. xi. Diseases of the Peripheral Cerebro-spinal Nerves. By Professor W. H. Erb. Translated by Mr. Henry Power. A. H. Buck, M.D., Editor of English Translation. London, 1876, 8vo, pp. 623. Br Foreign Med Chir Rev 1877; 60 (119) 23-32
• 17 Laugier A. Note sur la suture du nerf median. Gazette Hop (Paris) 1864; 75: 297
• 18 Houel M. Resection et suture du nerf median par M. Nelaton Gazette Hop (Paris) 1864; 75: 29677:307
• 19 Albert E. Einige Operationen an Nerven. Wien Med Presse 1885; 26: 1221-1224
• 20 Schmidt G. Eduard Albert and the beginning of human nerve grafting. Acta Chir Austriaca 1993; 25 (04) 287-288
• 21 Thorburn W. A clinical lecture on secondary suture of the brachial plexus. BMJ 1900; 1 (2053) 1073-1075
• 22 Kennedy R. Suture of the brachial plexus in birth paralysis of the upper extremity. Am Med Asso 1903; 1 (2197) 298-301
• 23 Taylor AS. Results from the surgical treatment of brachial birth palsy. J Am Med Assoc 1907; XLVIII (02) 96-104
• 24 Tuttle HK. Exposure of the brachial plexus with nerve-transplantation. J Am Med Assoc 1913; 61 (01) 15-17
• 25 Harris W, Low VW. On the importance of accurate muscular analysis in lesions of the brachial plexus; and the treatment of Erb's palsy and infantile paralysis of the upper extremity by cross-union of the nerve roots. BMJ 1903; 2 (2234) 1035-1038
• 26 Dawson GD, Scott JW. The recording of nerve action potentials through skin in man. J Neurol Neurosurg Psychiatry 1949; 12 (04) 259-267
• 27 Hodes R, Larrabee MG, German W. The human electromyogram in response to nerve stimulation and the conduction velocity of motor axons; studies on normal and on injured peripheral nerves. Arch Neurol Psychiatry 1948; 60 (04) 340-365
• 28 Woodhall B, Beebe GW. eds. Peripheral Nerve Regeneration: A Follow-Up Study of 3,656 World War II Injuries. Washington, DC: National Academies Press; 1957
• 29 Barnes R. Traction injuries of the brachial plexus in adults. J Bone Joint Surg Br 1949; 31B (01) 10-16
• 30 Taleb C, Nectoux E, Awada T, Liverneaux P. The destiny of an ace: Algimantas Otanas Narakas (1927-1993). J Brachial Plex Peripher Nerve Inj 2013; 8 (01) 6
• 31 Millesi H. Microsurgery of peripheral nerves. World J Surg 1979; 3 (01) 67-79 , 128–129
• 32 Millesi H. Surgical management of brachial plexus injuries. J Hand Surg Am 1977; 2 (05) 367-378
• 33 Hill JR, Lanier ST, Rolf L, James AS, Brogan DM, Dy CJ. Trends in brachial plexus surgery: characterizing contemporary practices for exploration of supraclavicular plexus. Hand (N Y) 2023; 18 (1_suppl, suppl): 14S-21S
• 34 Brown DL, Borschel GH, Levi B. Michigan Manual of Plastic Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2014
• 35 Luo TD, Levy ML, Li Z. Brachial Plexus Injuries.. Treasure Island, FL: StatPearls Publishing; 2023
• 36 Bush SH, Apte SM. Robotic-assisted surgery in gynecological oncology. Cancer Contr 2015; 22 (03) 307-313
• 37 Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc 2002; 16 (10) 1389-1402
• 38 Garcia Jr JC, Mantovani G, Gouzou S, Liveneaux P. Telerobotic anterior translocation of the ulnar nerve. J Robot Surg 2011; 5 (02) 153-156
• 39 Liverneaux P, Nectoux E, Taleb C. The future of robotics in hand surgery. Chir Main 2009; 28 (05) 278-285
• 40 Miyamoto H, Serradori T, Mikami Y. et al. Robotic intercostal nerve harvest: a feasibility study in a pig model. J Neurosurg 2016; 124 (01) 264-268
• 41 Porto de Melo P, Miyamoto H, Serradori T. et al. Robotic phrenic nerve harvest: a feasibility study in a pig model. Chir Main 2014; 33 (05) 356-360
• 42 Berner S. Nerve repair. In: Liverneaux P, Berner S, Bednar M, Parekattil S, Mantovani RG, Selber J. eds. Telemicrosurgery. Paris: Springer; 2013: 119-122
• 43 Lequint T, Naito K, Chaigne D, Facca S, Liverneaux P. Mini-invasive robot-assisted surgery of the brachial plexus: a case of intraneural perineurioma. J Reconstr Microsurg 2012; 28 (07) 473-476
• 44 Tetik C, Uzun M. Novel axillary approach for brachial plexus in robotic surgery: a cadaveric experiment. Minim Invasive Surg 2014; 2014: 927456
• 45 Jiang S, Ichihara S, Prunières G. et al. Robot-assisted C7 nerve root transfer from the contralateral healthy side: a preliminary cadaver study. Hand Surg Rehabil 2016; 35 (02) 95-99
• 46 Brahmbhatt JV, Gudeloglu A, Liverneaux P, Parekattil SJ. Robotic microsurgery optimization. Arch Plast Surg 2014; 41 (03) 225-230
• 47 Mantovani G, Liverneaux P, Garcia JC, Berner SH, Bednar MS, Mohr CJ. Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial. J Neurosurg 2011; 115 (03) 659-664