Subscribe to RSS
DOI: 10.1055/a-2241-5678
Bionische Chirurgie trifft Bionische Rekonstruktion – erstes in-human Projekt von robotischer Mikrochirurgie zur Targeted Muscle Reinnervation
Bionic Surgery Meets Bionic Reconstruction – First In-human use of Robotic Microsurgery in Targeted Muscle ReinnervationZusammenfassung
Robotische Mikrochirurgie ist ein wachsendes Feld in der rekonstruktiven Chirurgie und beinhaltet viele Vorteile wie eine optimale Ergonomie sowie eine Reduktion des physiologischen Tremors. Allerdings sind bis zum heutigen Zeitpunkt nur eine geringe Anzahl an robotischen Systemen verfügbar, die ein mikrochirurgisches Arbeiten ermöglichen. Nach wie vor ist die Durchführung einer robotischen mikrochirurgischen Nervenkoaptation eine Herausforderung in der klinischen Praxis. Targeted Muscle Reinnervation (TMR) ist eine innovative rekonstruktive Methode mit mehrfachen Nerventransfers zu den Muskeln des Amputationsstumpfes, welche zum einen die Neuromentwicklung verhindern und zum anderen die Anwendungsmöglichkeit einer bionischen Prothese verbessern sollen. Robotische Mikrochirurgie ermöglicht ein hohes Maß an Präzision und die Reduktion des physiologischen Tremors, verlangt jedoch hohe Investitionskosten was eine große Herausforderung für unser Gesundheitssystem darstellt. Zusammenfassend zeigt diese Studie die Möglichkeit der Anwendung von robotischer Mikrochirurgie in der peripheren Nervenchirurgie, insbesondere für Nerventransfers, bei denen eine präzise Durchführung in einem limitierten Platz durchgeführt werden muss. Zukünftige Studien werden das Potenzial von robotischer Mikrochirurgie für die peripheren Nervenchirurgen weiter evaluieren müssen
Abstract
Robotic microsurgery is an emerging field in reconstructive surgery, which provides benefits such as improved precision, optimal ergonomics, and reduced tremors. However, only a few robotic platforms are available for performing microsurgical procedures, and successful nerve coaptation is still a challenge. Targeted muscle reinnervation (TMR) is an innovative reconstructive procedure that rewires multiple nerves to remnant stump muscles, thereby reducing neuroma and phantom limb pain and improving the control of bionic prostheses. The precision of surgical techniques is critical in reducing axonal sprouting around the coaptation site to minimise the potential for neuroma formation. This study reports the first use of a microsurgical robotic platform for multiple nerve transfers in a patient undergoing TMR for bionic extremity reconstruction. The Symani robotic platform, combined with external microscope magnification, was successfully used, and precise handling of nerve tissue and coaptation was easily feasible even in anatomically challenging environments. While the precision and stability offered by robotic assistance may be especially useful for nerve surgery, the high economic costs of robotic microsurgery remain a major challenge for current healthcare systems. In conclusion, this study demonstrated the feasibility of using a robotic microsurgical platform for nerve surgery and transfers, where precise handling of tissue is crucial and limited space is available. Future studies will explore the full potential of robotic microsurgery in the future.
Schlüsselwörter
Chirurgie der peripheren Nerven - Nervenregeneration, Experimentelle Chirurgie - Neurotisation, Handchirurgie - Weiterbildung, Sonstige AspektePublication History
Received: 17 November 2023
Accepted: 27 December 2023
Article published online:
21 March 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Innocenti M, Malzone G, Menichini G. First-in-Human Free Flap Tissue Reconstruction Using a Dedicated Microsurgical Robotic Platform. Plast Reconstr Surg 2023; 151: 1078-1082 DOI: 10.1097/PRS.0000000000010108.
- 2 Aitzetmüller MM, Klietz ML, Dermietzel AF. et al. Robotic-Assisted Microsurgery and Its Future in Plastic Surgery. J Clin Med 2022; 11: 3378 DOI: 10.3390/JCM11123378.
- 3 van Mulken TJM, Schols RM, Scharmga AMJ. et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial. Nat Commun 2020; 11: 757 DOI: 10.1038/S41467-019-14188-W.
- 4 Aman M, Sporer ME, Gstoettner C. et al. Bionic hand as artificial organ: Current status and future perspectives. Artif Organs 2019; 43: 109-118 DOI: 10.1111/AOR.13422.
- 5 Dumanian GA, Potter BK, Mioton LM. et al. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. Ann Surg 2019; 270: 238-246 DOI: 10.1097/sla.0000000000003088.
- 6 Schäfer B, Bahm J, Beier JP. Nerve Transfers Using a Dedicated Microsurgical Robotic System. Plast Reconstr Surg Glob Open 2023; 11: e5192 DOI: 10.1097/GOX.0000000000005192.
- 7 Willems JIP, Shin AM, Shin DM. et al. A Comparison of Robotically Assisted Microsurgery versus Manual Microsurgery in Challenging Situations. Plast Reconstr Surg 2016; 137: 1317-1324 DOI: 10.1097/PRS.0000000000002030.
- 8 Marescaux J, Leroy J, Rubino F. et al. Transcontinental robot-assisted remote telesurgery: feasibility and potential applications. Ann Surg 2002; 235: 487-492 DOI: 10.1097/00000658-200204000-00005.
- 9 Barbon C, Grünherz L, Uyulmaz S. et al. Exploring the learning curve of a new robotic microsurgical system for microsurgery. JPRAS Open 2022; 34: 126-133 DOI: 10.1016/J.JPRA.2022.09.002.