Endoscopic telemicrosurgery or minimally invasive robotically-assisted microsurgery for peripheral nerve repair

Abstract

Microsurgery comprises a variety of surgical procedures such as neurovascular anastomoses, performed under optical magnification and with fine instrumentation. While refinements have been made since its advent in the 1960s, robotics offers the potential for major technological advancement. Endoscopic telemicrosurgery is minimally invasive, robotically-assisted microsurgery. This technique removes some limitations of conventional microsurgery and enhances visual and manual dexterity. Vision is enhanced through greater magnification, three-dimensionality, and functionalization, all through an endoscopic view. Manual dexterity is improved by suppression of physiological tremor and tremor filtration, while permitting useful enhancement of movement amplitudes and tactile feedback forces. Furthermore, better endoscopic ergonomics, new hand tools and the ability for multi-manual and remote work, confer a distinct advantage. Endoscopic telemicrosurgery is already in clinical use. Some of the advantages above are incorporated into the DaVinci ® robot, that is, used in brachial plexus surgery. Conventional brachial plexus surgery requires large incisions for exploration and neurotization, with its attending risks of unsightly scars, prolonged hospital stay, sepsis, and perineural adhesions that interfere with nerve regrowth. Endoscopic telemicrosurgery limits the incisions and these risks, with minimal compromise. Endoscopic telemicrosurgery, through the amplification of human capabilities may pave the way for a major advancement in the microsurgical field.