Telerobotic anterior translocation of the ulnar nerve

Abstract

The application of telerobotics in the biomedical field has grown rapidly and is showing very promising results. Robotically assisted microsurgery and nerve manipulation are some of its latest innovations. The purpose of this article is to update the community of shoulder and elbow surgeons on that field. Simple anterior subcutaneous translocation of the ulnar nerve was first experimented in two cadavers, and then performed in one live patient who presented with cubital tunnel syndrome. This procedure is the first reported case using the robot in elbow surgery. In this paper we attempt to analyze various aspects related to human versus robotically assisted surgery.

Endoscopic Robotic Decompression of the Ulnar Nerve at the Elbow

“…Orthopaedic surgery has just recently added this technology for open brachial plexus reconstruction, 14 as well as microsurgical nerve procedures. 13,15,16 The advantages of robotic surgery are as follows: (1) Tremor filtration makes the surgical procedure stable (6) Ergonomics is improved because the surgeon is out of the surgical field, seated in a comfortable position. 13 Future technologies, which are currently under development, will also allow the surgeon to browse the Internet, ask the opinion of another colleague online during the surgical procedure, use just a single portal for endoscopic approaches, perform local microscopic examinations in real time by using a microscope docked to the robot, and use specific markers that will provide a more reliable identification of the target structures.…”

“…The surgical technique was developed by adapting the open surgical technique of robotic anterior translocation of the ulnar nerve 13 to endoscopy. We used a new docking and setup for the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) based on the previous knowledge of endoscopic robotic techniques related to different surgical areas, such as urology and gynecology.…”

Telerobotic Manipulation of the Brachial Plexus

“…The surgeon controls the position of the robotic arms and simultaneously guides the endoscopic camera. 17 The three reported surgeries followed the traditional brachial plexus approach, with exploration and identification of the injured structures of the brachial plexus. During the neurorrhaphy, the Da Vinci ® equipment (Intuitive Surgical™, Sunnyvale, CA) was docked behind patient's head, and the microsurgical steps were performed using robotic telemanipulation (►Fig.…”

Robot Installation in Telemicrosurgery

“…5.2b ). In telemicrosurgery of the arm [ 6,13 ] , the patient is placed in dorsal decubitus, with 90° of abduction and 90° of external rotation of the shoulder and 90° of fl exion in the elbow, on an armrest. The robot can be positioned on either sides of the trunk, with the body of the robot adjacent to the contralateral upper limb and the surgical instruments on the side of the upper limb undergoing surgery ( Fig.…”