Page 80 - Read Online

Topic: Peripheral Nerve Repair and Regeneration

Endoscopic telemicrosurgery or minimally

invasive robotically-assisted microsurgery

for peripheral nerve repair

Satoshi Ichihara , Sybille Facca , Frédéric Bodin , Sarah Hendriks , André Gay ,
1
4
3
1,2
1
Philippe Liverneaux 1
1 Department of Hand Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, 67403 Illkirch, France.
2 Department of Orthopaedic Surgery, Juntendo University, Tokyo 1138421, Japan.
3 Department of Plastic Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, 67000 Strasbourg, France.
4 Department of Hand Surgery, La Timone Teaching Hospital, Aix Marseille Université, 13000 Marseille, France.
Address for correspondence: Dr. Philippe Liverneaux, Department of Hand Surgery, Strasbourg University Hospital, FMTS, University of
Strasbourg, 67403 Illkirch, France. E-mail: philippe.liverneaux@chru-strasbourg.fr

ABSTRACT
Microsurgery comprises a variety of surgical procedures such as neurovascular anastomoses, performed
under optical magnification and with fine instrumentation. While refinements have been made since
its advent in the 1960s, robotics offers the potential for major technological advancement. Endoscopic
telemicrosurgery is minimally invasive, robotically-assisted microsurgery. This technique removes
some limitations of conventional microsurgery and enhances visual and manual dexterity. Vision is
enhanced through greater magnification, three-dimensionality, and functionalization, all through an
endoscopic view. Manual dexterity is improved by suppression of physiological tremor and tremor
filtration, while permitting useful enhancement of movement amplitudes and tactile feedback forces.
Furthermore, better endoscopic ergonomics, new hand tools and the ability for multi-manual and remote
work, confer a distinct advantage. Endoscopic telemicrosurgery is already in clinical use. Some of the
advantages above are incorporated into the DaVinci robot, that is, used in brachial plexus surgery.
®
Conventional brachial plexus surgery requires large incisions for exploration and neurotization, with
its attending risks of unsightly scars, prolonged hospital stay, sepsis, and perineural adhesions that
interfere with nerve regrowth. Endoscopic telemicrosurgery limits the incisions and these risks, with
minimal compromise. Endoscopic telemicrosurgery, through the amplification of human capabilities
may pave the way for a major advancement in the microsurgical field.

Key words:
DaVinci, endoscopy, microsurgery, robot

INTRODUCTION optical magnification allows a better visualization of tissue
structures than with the naked eye. The term “microsurgery”,
Microsurgery is the surgical technique that uses both optical is sometimes abused because the optical magnification of
magnification and fine instruments in order to perform surgical microscopes and surgical magnifying glasses does
inframillimetric vascular and nerve anastomoses. The not exceed forty times, at best fifty times better with some
supermicrosurgical microscopes. A surgical microscope must
therefore be considered as binocular magnifying glass, that
Access this article online
can visualize structures invisible to the naked eye and is not,
Quick Response Code: strictly speaking, a microscope.
Website:
www.parjournal.net
Microsurgical instruments provide a better repair of tissue
damage than conventional instruments. Their design
DOI: comes from the craft of watchmaking, whose forceps
10.4103/2347-9264.158860 are identical. Microsurgery approaches watchmaking in
which one uses a monocular magnifying glass placed over

220 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015