Abstract
New developments in the surgery of the brachial plexus include the use of less invasive
surgical approaches and more precise techniques. The theoretical advantages of the
use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional
vision, high definition, magnification, and superior ergonomics.
On a fresh cadaver, a dissection space was created and maintained by insufflation
of CO2. The supraclavicular brachial plexus was dissected using the da Vinci robot (Intuitive
Surgical, Sunnyvale, CA). A segment of the C5 nerve root was grafted robotically.
A series of eight clinical cases of nerve damage around the shoulder girdle were operated
on using the da Vinci robot. The ability to perform successful microneural repair
was confirmed in both the authors' clinical and experimental studies, but the entire
potential of robotically assisted microneural surgery was not realized during these
initial cases because an open incision was still required.
Robotic-assisted surgery of the shoulder girdle and brachial plexus is still in its
early stages. It would be ideal to have even finer and more suitable instruments to
apply fibrin glue or electrostimulation in nerve surgery. Nevertheless, the prospects
of minimally invasive techniques would allow acute and subacute surgical approach
of traumatic brachial plexus palsy safely, without significant and cicatricial morbidity.
Keywords
brachial plexus - da Vinci robot - telemicrosurgery - shoulder girdle
