title: Nerve transfer to the deltoid muscle using the nerve to the long head of the triceps with the da Vinci robot: six cases.
abstract: BACKGROUND
  Nerve transfer to the deltoid muscle using the nerve to the long head of the triceps is a reliable method for restoration of deltoid function. The aim of this retrospective study was to report the results of nerve transfer to the deltoid muscle using the nerve to the long head of the triceps procedure using a robot.
  
  
  METHODS
  Our series included six patients (mean age 36.3 years) with total deltoid muscle paralysis. A da Vinci-S robot was placed in position. After dissection of the quadrilateral and triangular spaces, the anterior branch of the axillary nerve and the branch to the long head of the triceps were transected, and then robotically sutured with two 10-0 nylon stiches. In two cases, an endoscopic procedure was tried under carbon dioxide (CO2) insufflation.
  
  
  RESULTS
  In all patients except one, deltoid function against resistance (M4) was obtained at the last follow-up evaluation. The average shoulder abduction was 112 degrees. No weakness of elbow extension was observed. In two cases with the endoscopic technique, vision was blurred and conversion to open technique was performed.
  
  
  CONCLUSIONS
  The advantages of robotic microsurgery are motion scaling and disappearance of physiological tremor. Reasons for failure of the endoscopic technique could be explained by insufficient pressure. We had no difficulty using the robot without the sensory feedback. The robot-assisted nerve transfer to deltoid muscle using the nerve to the long head of the triceps was a feasible application for restoration of shoulder abduction after brachial plexus or axillary nerve injury. Therapeutic Study. Level of Evidence IV.
authors: Department of Hand Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors: Hideaki
authors: H
authors: Miyamoto
authors: Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.
authors: Somsak
authors: S
authors: Leechavengvongs
authors: Central Jersey Hand Surgery, PA, Eatontown, New Jersey.
authors: Teddy
authors: T
authors: Atik
authors: Department of Hand Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors: Sybille
authors: S
authors: Facca
authors: Department of Hand Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors: Philippe
authors: P
authors: Liverneaux
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000601:surgery*; D061887:Conversion to Open Surgery; D057645:Deltoid Muscle / Q000294:innervation*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000601:surgery; D016067:Nerve Transfer / Q000379:methods*; D010243:Paralysis / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012785:Shoulder Joint / Q000502:physiology