title: Robot-assisted surgery of the shoulder girdle and brachial plexus.
abstract: New developments in the surgery of the brachial plexus include the use of less invasive surgical approaches and more precise techniques. The theoretical advantages of the use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional vision, high definition, magnification, and superior ergonomics. On a fresh cadaver, a dissection space was created and maintained by insufflation of CO2. The supraclavicular brachial plexus was dissected using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA). A segment of the C5 nerve root was grafted robotically. A series of eight clinical cases of nerve damage around the shoulder girdle were operated on using the da Vinci robot. The ability to perform successful microneural repair was confirmed in both the authors' clinical and experimental studies, but the entire potential of robotically assisted microneural surgery was not realized during these initial cases because an open incision was still required. Robotic-assisted surgery of the shoulder girdle and brachial plexus is still in its early stages. It would be ideal to have even finer and more suitable instruments to apply fibrin glue or electrostimulation in nerve surgery. Nevertheless, the prospects of minimally invasive techniques would allow acute and subacute surgical approach of traumatic brachial plexus palsy safely, without significant and cicatricial morbidity.
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Sybille
authors.initials: S
authors.lastname: Facca
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hendriks
authors.affiliation: Department of Hand Surgery, Sao Paolo Hand center, Ben Portuguesa Hospital, Sao Paolo, Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Mantovani
authors.affiliation: Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Liverneaux
keywords: brachial plexus; da Vinci robot; shoulder girdle; telemicrosurgery