Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial

Laboratory investigation

Gustavo MantovaniDepartment of Hand Surgery, “Beneficência Portuguesa de São Paulo” Hospital;

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Philippe LiverneauxDepartment of Hand Surgery, Strasbourg University Hospitals, Illkirch, France;

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Jose Carlos Garcia Jr.Division of Sports Medicine, Pontifical Catholic University of Campinas, São Paulo, Brazil;

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Stacey H. BernerDepartment of Hand Surgery, Sinai Hospital of Baltimore, Maryland;

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Michael S. BednarDepartment of Orthopaedic Surgery, Loyola University, Maywood, Illinois; and

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Catherine J. MohrDepartment of Surgery, Stanford School of Medicine, Stanford, California

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Object

The aim of this paper was to develop an effective minimally invasive approach to brachial plexus surgery and to determine the feasibility of using telerobotic manipulation to perform a diagnostic dissection and microsurgical repair of the brachial plexus utilizing an entirely endoscopic approach.

Methods

The authors performed an endoscopic approach using 3 supraclavicular portals in 2 fresh human cadaver brachial plexuses with the aid of the da Vinci telemanipulation system. Dissection was facilitated inflating the area with CO2 at 4 mm Hg pressure. The normal supraclavicular plexus was dissected in its entirety to confirm the feasibility of a complete supraclavicular brachial plexus diagnostic exploration. Subsequently, an artificial lesion to the upper trunk was created, and nerve graft reconstruction was performed. Images and video of the entire procedure were obtained and edited to illustrate the technique.

Results

All supraclavicular structures of the brachial plexus could be safely dissected and identified, similar to the experience in open surgery. The reconstruction of the upper trunk with nerve graft was successfully completed using an epineural microsurgical suture technique performed exclusively with the aid of the robot. There were no instances of inadvertent macroscopic damage to the vascular and nervous structures involved.

Conclusions

An endoscopic approach to the brachial plexus is feasible. The use of the robot makes it possible to perform microsurgical procedures in a very small space with telemanipulation and minimally invasive techniques. The ability to perform a minimally invasive procedure to explore and repair a brachial plexus injury may provide a new option in the acute management of these injuries.

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  • 1

    Braga-Silva J, , Gehlen D, & Kuyven CR: Endoscopic exploration of a brachial plexus injury. J Reconstr Microsurg 22:539541, 2006

  • 2

    Doi K, , Otsuka K, , Okamoto Y, , Fujii H, , Hattori Y, & Baliarsing AS: Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg 96:3 Suppl 277284, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Hems TE, , Birch R, & Carlstedt T: The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus. J Hand Surg Br 24:550555, 1999

    • Search Google Scholar
    • Export Citation
  • 4

    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 54:401409, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Landi A, & Copeland SA: Value of the Tinel sign in brachial plexus lesions. Ann R Coll Surg Engl 61:470471, 1979

  • 6

    Landi A, , Copeland SA, , Parry CB, & Jones SJ: The role of somatosensory evoked potentials and nerve conduction studies in the surgical management of brachial plexus injuries. J Bone Joint Surg Br 62-B:492496, 1980

    • Search Google Scholar
    • Export Citation
  • 7

    Millesi H: Surgical management of brachial plexus injuries. J Hand Surg Am 2:367378, 1977

  • 8

    Monsivais JJ, , Narakas AO, , Turkof E, & Sun Y: The endoscopic diagnosis and possible treatment of nerve root avulsions in the management of brachial plexus injuries. J Hand Surg Br 19:547549, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Narakas AO: Surgical treatment of traction injuries of the brachial plexus. Clin Orthop Relat Res 133:7190, 1978

  • 10

    Narakas AO: The treatment of brachial plexus injuries. Int Orthop 9:2936, 1985

  • 11

    Nectoux E, , Taleb C, & Liverneaux P: Nerve repair in telemicrosurgery: an experimental study. J Reconstr Microsurg 25:261265, 2009

  • 12

    Nichols AW: Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep 8:240249, 2009

  • 13

    Stevens JH: Brachial plexus paralysis. By J.H. Stevens, M.D., 1934. Clin Orthop Relat Res 237:48, 1988

  • 14

    Taleb C, , Nectoux E, & Liverneaux PA: Limb replantation with two robots: a feasibility study in a pig model. Microsurgery 29:232235, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Taleb C, , Nectoux E, & Liverneaux PA: Telemicrosurgery: a feasibility study in a rat model. Chir Main 27:104108, 2008

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