title: Telerobotic manipulation of the brachial plexus.
abstract: OBJECTIVE
  This study demonstrates the new technology of the robotic telesurgery on three brachial plexus reconstructions. We also discuss the implications, problems, and benefits of robotically assisted brachial plexus surgery.
  
  
  METHODS
  After the first experimental experience in a cadaveric model, the authors performed three brachial plexus reconstructions. The surgery followed the traditional brachial plexus approach. From the moment that nervous sutures would be performed, the Da Vinci® (Intuitive Surgical™, Sunnyvale, CA) equipment was docked at the patients, positioned behind the patient's head, and the microsurgical steps were performed by using robotic telemanipulation.
  
  
  RESULTS
  The first procedure was performed in a cadaver to gain experience and establish a surgical protocol by using the robot. In all the three living patients, the goals of the surgical procedure were achieved using the telerobotic manipulation.
  
  
  CONCLUSIONS
  Robot-assisted surgery allows performance of high-dexterity surgical operations with the help of robotic arms and it improves the surgery due to tremor filtration, motion scaling, and ergonomics. The benefit of using the robot on microsurgery was reached, but its entire potential was not realized because the instruments used on those first experimental and clinical cases were not specifically designed for microsurgery.
authors.affiliation: Department of Shoulder and Elbow Surgery, NAEON-Center for Advanced Studies in Orthopedics and Neurosurgery, Sao Paulo, Brazil. josecarlos@especialistadoombro.com.br
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Garcia
authors.forename: Frederic
authors.initials: F
authors.lastname: Lebailly
authors.forename: Gustavo
authors.initials: G
authors.lastname: Mantovani
authors.forename: Leonardo Alves
authors.initials: LA
authors.lastname: Mendonca
authors.forename: Jesely
authors.initials: J
authors.lastname: Garcia
authors.forename: Philippe
authors.initials: P
authors.lastname: Liverneaux
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D006801:Humans; D008297:Male; D012371:Robotics; D017216:Telemedicine; D055815:Young Adult