Download PDF
CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(01): e19-e26
DOI: 10.1055/a-2134-8633
Case Report

How a Robotic Visualization System Can Facilitate Targeted Muscle Reinnervation

Vesta Brauckmann   *
1   Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
,
Jorge R. Mayor   *
1   Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
,
Luisa Ernst
2   Study Program Medical Engineering, Technologies and Development Processes, Furtwangen University, Tuttlingen, Germany
,
Jennifer Ernst
1   Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Innovations in medical technologies have impacted surgery sustainably in the last decades. To enable and further improve microsurgical outcomes, different loupes and optic-based microscopes have been proposed in recent years. In amputation surgery continuous progress and prosthetic developments have provided amputees with an improved degree of function and quality of life.

Herein, we present a 17-year-old patient who suffered a traumatic loss of the left upper limb and underwent target muscle reinnervation surgery facilitated by a three-dimensional (3D) robotic exoscope system.

Methods The rerouting of the distal ends of the arm nerves (TMR) was performed in the upper limb of a traumatic transhumeral amputee patient using a 3D robotic exoscope system (RS, RoboticScope, BHS Technologies, Innsbruck, Austria). Perioperative data was collected and compared to standard. Users' perspective evaluation of the system during the surgical procedure was done using a 5-point Likert scale.

Results Operation time was 311 minutes, the robotic system was used for 101 minutes. Overall users' evaluation revealed a 4.5 for the selected items on the Likert scale. The evaluation showed similar results in the evaluation of the system by the main and assistant surgeons. No special training was required beforehand. The bimanual control allowed for improved personal freedom in the surgical field at a comfortable position. The imaging of colors will need future improvements until an authentic representation of in situ structures is achieved.

Conclusion Major advantages of a robotic scope 3D exoscope system are improved image quality, ergonomic position, and increased accessibility in a wider operating field due to system-implied features. Another benefit is digital documentation and simultaneous education through the possibility of capturing images and videos, as well as easy transportation in between operating rooms without risk to harm the vulnerable optic. Digital microscopes are still associated with high acquisition costs, and they are not yet implemented as standard of care due to limited experience.

Keywords

robotic surgery - computer-assisted surgery - image-guided surgery - TMR - transhumeral amputation - targeted muscle reinnervation

* These authors contributed equally to this research article and retain the first authorship.




Publication History

Received: 11 November 2022

Accepted: 08 June 2023

Accepted Manuscript online:
21 July 2023

Article published online:
05 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (03) 422-429
    CrossrefPubMedGoogle Scholar
  • 2 Kuiken TA, Barlow AK, Hargrove L, Dumanian GA. Targeted muscle reinnervation for the upper and lower extremity. Tech Orthop 2017; 32 (02) 109-116
    CrossrefPubMedGoogle Scholar
  • 3 Wimalawansa SM, Lygrisse D, Anderson SR. et al. Targeted muscle reinnervation in partial hand amputations. Plast Reconstr Surg Glob Open 2021; 9 (05) e3542
    CrossrefPubMedGoogle Scholar
  • 4 Valerio IL, Dumanian GA, Jordan SW. et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg 2019; 228 (03) 217-226
    CrossrefPubMedGoogle Scholar
  • 5 Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res 2014; 472 (10) 2984-2990
    CrossrefPubMedGoogle Scholar
  • 6 Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. J Biomed Opt 2021; 26 (01) 1-74
    PubMedGoogle Scholar
  • 7 Piatkowski AA, Keuter XHA, Schols RM, van der Hulst RRWJ. Potential of performing a microvascular free flap reconstruction using solely a 3D exoscope instead of a conventional microscope. J Plast Reconstr Aesthet Surg 2018; 71 (11) 1664-1678
    CrossrefPubMedGoogle Scholar
  • 8 Piloni M, Bailo M, Gagliardi F, Mortini P. Resection of intracranial tumors with a robotic-assisted digital microscope: a preliminary experience with robotic scope. World Neurosurg 2021; 152: e205-e211
    CrossrefPubMedGoogle Scholar
  • 9 Gonen L, Chakravarthi SS, Monroy-Sosa A. et al. Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications. Neurosurg Focus 2017; 42 (05) E9
    CrossrefPubMedGoogle Scholar
  • 10 Maurer S, Prinz V, Qasem LE. et al. Evaluation of a novel three-dimensional robotic digital microscope (Aeos) in neurosurgery. Cancers (Basel) 2021; 13 (17) 4273
    CrossrefPubMedGoogle Scholar
  • 11 Sun X, Okamoto J, Masamune K, Muragaki Y. Robotic technology in operating rooms: a review. Curr Robot Rep 2021; 2 (03) 333-341
    CrossrefPubMedGoogle Scholar
  • 12 Chen LWY, Goh M, Goh R. et al. Robotic-assisted peripheral nerve surgery: a systematic review. J Reconstr Microsurg 2021; 37 (06) 503-513
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Scaglioni MF, Meroni M, Fritsche E, Linder T, Rajan G. Use of the BHS robotic scope to perform lymphovenous anastomosis. Microsurgery 2021; 41 (03) 298-299
    CrossrefPubMedGoogle Scholar
  • 14 Riepl R, Greve J, Schild LR. et al. Application of a new computer-assisted robotic visualization system in cochlear implantation-Proof of concept. Int J Med Robot 2021; 17 (05) e2301
    CrossrefPubMedGoogle Scholar
  • 15 Schär M, Röösli C, Huber A. Preliminary experience and feasibility test using a novel 3D virtual-reality microscope for otologic surgical procedures. Acta Otolaryngol 2021; 141 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 16 Gart MS, Souza JM, Dumanian GA. Targeted muscle reinnervation in the upper extremity amputee: a technical roadmap. J Hand Surg Am 2015; 40 (09) 1877-1888
    CrossrefPubMedGoogle Scholar
  • 17 Rossi-Moussuti F, Timo E, Germann M. Barges-Coll J. Robotic-assisted minimally invasive transforaminal interbody fusion (TLIF) using a new hands-free 3D digital microscope with head-mounted-display (HMD): technical note. Intl J Clin Images Med Rev 2021; 1 (01) 1004
    PubMedGoogle Scholar
  • 18 Lakhiani C, Fisher SM, Janhofer DE, Song DH. Ergonomics in microsurgery. J Surg Oncol 2018; 118 (05) 840-844
    CrossrefPubMedGoogle Scholar
  • 19 Khansa I, Khansa L, Westvik TS, Ahmad J, Lista F, Janis JE. Work-related musculoskeletal injuries in plastic surgeons in the United States, Canada, and Norway. Plast Reconstr Surg 2018; 141 (01) 165e-175e
    CrossrefPubMedGoogle Scholar
  • 20 Boehm F, Schuler PJ, Riepl R, Schild L, Hoffmann TK, Greve J. Performance of microvascular anastomosis with a new robotic visualization system: proof of concept. J Robot Surg 2022; 16 (03) 705-713
    CrossrefPubMedGoogle Scholar
  • 21 Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina 2016; 36 (01) 137-147
    CrossrefPubMedGoogle Scholar
  • 22 Minoda R, Miwa T. Non-microscopic middle ear cholesteatoma surgery: a case report of a novel head-up approach. Otol Neurotol 2019; 40 (06) 777-781
    CrossrefPubMedGoogle Scholar
  • 23 Troisi L, Pajardi GE. How SARS-CoV-2 has changed the activities in a regional hand surgery centre in Italy. J Hand Microsurg 2020; 12 (02) 132-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Tan YPA, Liverneaux P, Wong JKF. Current limitations of surgical robotics in reconstructive plastic microsurgery. Front Surg 2018; 5: 22
    CrossrefPubMedGoogle Scholar
  • 25 Hafez A, Haeren RHL, Dillmann J, Laakso A, Niemelä M, Lehecka M. Comparison of operating microscope and exoscope in a highly challenging experimental setting. World Neurosurg 2021; 147: e468-e475
    CrossrefPubMedGoogle Scholar
  • 26 RoboticScope What if. Accessed August 3, 2023, at: https://www.bhs-technologies.com/wp-content/uploads/2021/12/BHS_Broschuere-A4-download.pdf
    PubMedGoogle Scholar