Robotic Assisted Peripheral Nerve Surgery - a Systematic Review
Lisa Wen-Yu Chen, MD, Chang Gang Memorial Hospital, Taoyuan, Taiwan
Abstract
Introduction:
Telerobotic techniques are a tremendous revolution in modern surgery, and their advantages and indications have been well discussed in different specialties. However, the use of telerobotic in peripheral nerve reconstruction is still limited. This study aims to identify the current clinical applications, evaluate the advantages and disadvantages to establish potential applications in the future, and to discuss the innovations in this field.
Materials & Methods:
A literature review of PubMed database was performed to identify studies focusing on different telerobotic peripheral nerve interventions. Data on the approach, dissection, and nerve management via robotic system were collected. The unpublished innovations, as well as the possibly improvable and developable fields were also discussed.
Results:
Nineteen studies were selected and reviewed, including pre-clinical experimental researches and clinical reports. Articles covered robotic-assisted brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. Among 53 clinical cases, only 20 (37.7%) cases completed a successful minimally invasive approach and robotic intervention of the nerve ; 17 (32.1%) cases underwent conventional approach with the nerves intervened robotically; 12 (22.6%) cases converted to open approach maintaining a robotic intervention of the nerve; and 4 (7.5%) cases converted to open surgery. Likewise, robotic interventions have been approved in the fields of sympathetic trunk reconstruction and nipple neurotization after breast cancer resection using intercostal nerves, showing positive clinical effects.
Conclusions:
Robotic-assisted surgery is still in a developing stage in peripheral nerve reconstruction. However, clinical achievements have been shown in specific fields. We believe the telerobotic system will become more popular in the future, especially when applying it in deep areas of the body in which a conventional approach is difficult, or in challenging scenarios that require cooperation with other specialties.
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