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Structured Motor Rehabilitation After Selective Nerve Transfers
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Nerve Transfers Using a Dedicated Microsurgical Robotic System.

Benedikt Schäfer1,2, Jörg Bahm1,2, Justus P Beier1

  • 1From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany.

Plastic and Reconstructive Surgery. Global Open
|August 16, 2023
PubMed
Summary

Robotic microsurgery enables precise coaptation of small nerves, even in difficult-to-reach areas. This technology enhances peripheral nerve repair for complex cases like brachial plexus palsy.

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Area of Science:

  • Neurosurgery
  • Microsurgery
  • Robotic Surgery

Background:

  • Microsurgical demands in peripheral nerve surgery are increasing due to advancements in nerve transfers.
  • Transposing and coapting small nerves and single fascicles require advanced microsurgical skills.
  • Limited surgical access in certain anatomical regions presents challenges for conventional microsurgical techniques.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of robotic technology for epineural coaptation of small peripheral nerves.
  • To assess the precision and accuracy of robotic-assisted microsurgery in challenging anatomical locations.
  • To explore the potential of robotic systems in performing complex nerve transfers.

Main Methods:

  • The Symani Surgical System, a robotic technology, was utilized for epineural coaptation.
  • Three donor nerves (intercostal nerves 4-6) were coapted to recipient nerves (long thoracic and thoracodorsal nerves) in a patient with brachial plexus palsy.
  • A high-magnification (up to 26×) 3D-exoscope was used in conjunction with the robotic system.

Main Results:

  • Successful epineural coaptations of the donor and recipient nerves were achieved using the microsurgical robot.
  • The robotic system, combined with the 3D-exoscope, allowed for precise and accurate placement of epineural sutures.
  • The procedure demonstrated the capability of robotic technology to handle very small nerve structures.

Conclusions:

  • Robotic microsurgery, specifically the Symani Surgical System, enables successful coaptation of very small nerve structures.
  • This technology facilitates finer, more targeted, and complex nerve transfers.
  • Robotic assistance expands surgical possibilities, particularly in anatomically difficult-to-reach regions for peripheral nerve repair.