Department of Hand Surgery, Beneficência Portuguesa de São Paulo Hospital, São Paulo, Brazil.
J Neurosurg. 2011 Sep;115(3):659-64. doi: 10.3171/2011.3.JNS10931. Epub 2011 Apr 8.
The aim of this paper was to develop an effective minimally invasive approach to brachial plexus surgery and to determine the feasibility of using telerobotic manipulation to perform a diagnostic dissection and microsurgical repair of the brachial plexus utilizing an entirely endoscopic approach.
The authors performed an endoscopic approach using 3 supraclavicular portals in 2 fresh human cadaver brachial plexuses with the aid of the da Vinci telemanipulation system. Dissection was facilitated inflating the area with CO(2) at 4 mm Hg pressure. The normal supraclavicular plexus was dissected in its entirety to confirm the feasibility of a complete supraclavicular brachial plexus diagnostic exploration. Subsequently, an artificial lesion to the upper trunk was created, and nerve graft reconstruction was performed. Images and video of the entire procedure were obtained and edited to illustrate the technique.
All supraclavicular structures of the brachial plexus could be safely dissected and identified, similar to the experience in open surgery. The reconstruction of the upper trunk with nerve graft was successfully completed using an epineural microsurgical suture technique performed exclusively with the aid of the robot. There were no instances of inadvertent macroscopic damage to the vascular and nervous structures involved.
An endoscopic approach to the brachial plexus is feasible. The use of the robot makes it possible to perform microsurgical procedures in a very small space with telemanipulation and minimally invasive techniques. The ability to perform a minimally invasive procedure to explore and repair a brachial plexus injury may provide a new option in the acute management of these injuries.
本文旨在开发一种有效的微创臂丛神经手术方法，并确定使用远程机器人操作通过完全内窥镜入路进行臂丛神经诊断性解剖和显微修复的可行性。
作者在达芬奇远程操作机器人的辅助下，通过 3 个锁骨上入路对 2 具新鲜人体尸头的臂丛神经进行了内镜入路操作。通过在 4 毫米汞柱压力下向该区域充气来促进解剖。对正常锁骨上丛进行完整解剖，以确认完全锁骨上臂丛神经诊断性探查的可行性。随后，人为对上干造成损伤，并进行神经移植重建。获得并编辑了整个手术过程的图像和视频以说明技术。
所有臂丛神经的锁骨上结构都可以安全地解剖和识别，与开放手术的经验相似。使用神经移植成功完成了对上干的重建，采用的是仅借助机器人进行的神经外膜显微缝合技术。没有意外地对涉及的血管和神经结构造成宏观损伤的情况。
内镜入路进行臂丛神经手术是可行的。机器人的使用使得通过远程操作和微创手术技术在非常小的空间内进行显微手术成为可能。进行微创探查和修复臂丛神经损伤的能力可能为这些损伤的急性处理提供新的选择。
