Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Abstract

Background Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. Methods A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. Results Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. Conclusion Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.

Reversal of thoracic sympathectomy through robot‐assisted microsurgical sympathetic trunk reconstruction with sural nerve graft and additional end‐to‐side coaptation of the intercostal nerves: A case report

“…Robot-assisted microsurgical reconstruction of the sympathetic trunk represents a breakthrough as they facilitate the microdissection, identification of the healthy nerve stumps, and the reliable microscopic suturing. Still, their use is very limited mainly to large centers, as they require specific training with an own learning curve (Chang et al, 2020;Chen et al, 2021). This case demonstrates the clinical feasibility of treating the longterm side effects after ETS being CH or other adverse effects due to the sympathectomy.…”

More than surgical tools: a systematic review of robots as didactic tools for the education of professionals in health sciences

“…Secondly, it is often difficult to establish if they are system-centric or application-centric didactic tools. Last but not least, there exists extensive and recent review bibliography in the field, as it has been one of the main subjects of technology-related medical education during the last decades (Chen et al, 2020a , b ; Ginoya et al, 2021 ; Sharma & Bhardwaj, 2021 ; Chen et al, 2021 ; Bonatti et al, 2021 ).…”

“…Such definitions have a strong bias towards early industrial robots as manipulators that can grasp and move objects in industrial environments. Nowadays, robots can cooperate closely with humans to perform jobs with greater precision and efficiency, for example surgical robots (Bonatti et al, 2021 ; Chen et al, 2021 ; Sharma & Bhardwaj, 2021 ), with an increasing importance since the COVID-19 pandemic.…”

“…In terms of survey papers, there has been extensive review bibliography in the field of medical robotics (Cianchetti et al, 2018 ; Troccaz et al, 2019 ). Most of the recent surveys focus on surgical robots (Chen et al, 2021 ; Chen et al, 2020a , b ; Gifari et al, 2019 ; Simaan et al, 2018 ; Peters et al, 2018 ; Díaz et al, 2017 ) and rehabilitation and assistive robots (Giansanti, 2021 ; Meng et al, 2017 ; Mohebbi, 2020 ; Rupal et al, 2017 ).…”

Thoracic surgery in Taiwan

“…Our group performs this operation through a multi-disciplinary approach that involves two distinct teams specializing in thoracic surgery and plastic-reconstructive surgery (microsurgery subspecialty), respectively. Such a combination may allow achieving an increased attention to fine surgical details, which eventually results in sustained clinical benefits ( 53 ).…”