Nerve repair in telemicrosurgery: an experimental study

Since the development of microsurgery in the 1960s, the prognosis of peripheral nerve lesions has greatly improved. However this new technique's evolution has remained limited by human factors, in particular by physiological tremor. Telesurgery, a technique used in other surgical fields, was developed in the 1990s. This study assesses the feasibility of peripheral nerve repair using telemicrosurgery. Anatomical material from three subjects of different species (rat, pig, and human) was used. The telesurgical step of the procedure was performed with a Da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA). Four anatomical epiperineural repairs were performed. Another neurotrophic repair was performed with a nerve regrowth guide. Regardless of the type of repair performed, the telemanipulator removed the physiological tremor factor. The suture needle was distorted when held by two clamps at a time. Repairs were all performed without any damaging twisting movements of both nerve ends. Our results demonstrated that telesurgery allows very safe and precise peripheral nerve repairs by counteracting physiological tremor and by improving the overview of the surgical field, either with an anatomical or a neurotrophic technique.