Minimally Invasive Techniques for Intercostal Nerve Transfer: A Technical Note on Thoracoscopic and Robotic...

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Brachial plexus injuries can lead to severe limb dysfunction.
• Restoring elbow flexion is crucial for patients lacking intraplexal donors.
• Current nerve transfer surgeries can be lengthy with significant recovery pain.

Purpose of the Study:

• To demonstrate minimally invasive techniques for harvesting intercostal (IC) nerves.
• To evaluate video-assisted thoracoscopic surgery (VATS) and robotic approaches for IC nerve harvesting.
• To assess the feasibility of these techniques for nerve reanimation in brachial plexus injuries.

Main Methods:

• Cadaveric study utilizing VATS with 3 ports for IC nerve 3 harvest.
• Robotic approach used on a separate cadaver to harvest IC nerves 3, 4, and 5.
• Coaptation of harvested IC nerve to the nerve to biceps brachii.

Main Results:

• Successful thoracoscopic harvest of IC nerve 3 using VATS in 55 minutes.
• Successful robotic harvest of IC nerves 3, 4, and 5.
• Average robotic harvest time per nerve was 27 minutes.

Conclusions:

• VATS and robotic techniques provide a cadaveric proof of concept for minimally invasive IC nerve harvesting.
• These intrathoracic approaches show potential for treating brachial plexus injuries.
• Further research is needed to explore intrathoracic approaches for reanimating other peripheral nerves.