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Hideaki MIYAMOTO

University of Tokyo Hospital
Tokyo, Japan
MD
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Neurotisation to the axillary nerve by the nerve to the triceps
Nerve transfer to the deltoid muscle using the nerve of the long head of the triceps is a reliable method for deltoid function restoration. The aim of this retrospective study was to report the results of the nerve transfer procedure to the deltoid muscle using the nerve of the long head of the triceps by means of a robot.
Our series included six patients (mean age: 36.3 years) with total deltoid muscle paralysis. A da Vinci S® robot was placed in position. After dissection of the quadrilateral and triangular spaces, the anterior branch of the axillary nerve and the branch to the long head of the triceps were transected, then robotically sutured with two 10/0 Nylon stitches. In 2 cases, an endoscopic procedure was attempted under carbon dioxide insufflation.
In all patients except one, deltoid function against resistance (M4) was obtained at the last follow-up evaluation. The average shoulder abduction was 112 degrees. No elbow extension weakness was observed. In 2 cases with the endoscopic technique, vision was blurred and conversion to the open technique was performed.
The advantages of robotic microsurgery are motion scaling and disappearance of physiological tremors. Reasons for failure of the endoscopic technique could be explained by insufficient pressure. We had no difficulty using the robot without sensory feedback. The robot-assisted nerve transfer to the deltoid muscle using the nerve of the long head of the triceps was a feasible application for restoration of shoulder abduction after brachial plexus or axillary nerve injury.
H Miyamoto
Lecture
5 years ago
66 views
2 likes
0 comments
07:07
Neurotisation to the axillary nerve by the nerve to the triceps
Nerve transfer to the deltoid muscle using the nerve of the long head of the triceps is a reliable method for deltoid function restoration. The aim of this retrospective study was to report the results of the nerve transfer procedure to the deltoid muscle using the nerve of the long head of the triceps by means of a robot.
Our series included six patients (mean age: 36.3 years) with total deltoid muscle paralysis. A da Vinci S® robot was placed in position. After dissection of the quadrilateral and triangular spaces, the anterior branch of the axillary nerve and the branch to the long head of the triceps were transected, then robotically sutured with two 10/0 Nylon stitches. In 2 cases, an endoscopic procedure was attempted under carbon dioxide insufflation.
In all patients except one, deltoid function against resistance (M4) was obtained at the last follow-up evaluation. The average shoulder abduction was 112 degrees. No elbow extension weakness was observed. In 2 cases with the endoscopic technique, vision was blurred and conversion to the open technique was performed.
The advantages of robotic microsurgery are motion scaling and disappearance of physiological tremors. Reasons for failure of the endoscopic technique could be explained by insufficient pressure. We had no difficulty using the robot without sensory feedback. The robot-assisted nerve transfer to the deltoid muscle using the nerve of the long head of the triceps was a feasible application for restoration of shoulder abduction after brachial plexus or axillary nerve injury.
Robotic thoracoscopy: intercostal nerves and phrenic nerve harvesting
The aim of this study was to report the feasibility of robotic intercostal nerve harvesting in a pig model. A surgical robot (the da Vinci S® system, Intuitive Surgical, Sunnyvale, CA) was installed with three ports on the pig’s left chest. The posterior edges of the 4th, 5th, and 6th intercostal nerves were isolated to the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvests were successfully performed in 40 minutes without major complications. The advantages of robotic microsurgery for intercostal nerve harvesting are motion scaling up to 5 times, elimination of physiological tremors, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvesting for brachial plexus reconstruction.
H Miyamoto
Lecture
5 years ago
149 views
5 likes
0 comments
06:07
Robotic thoracoscopy: intercostal nerves and phrenic nerve harvesting
The aim of this study was to report the feasibility of robotic intercostal nerve harvesting in a pig model. A surgical robot (the da Vinci S® system, Intuitive Surgical, Sunnyvale, CA) was installed with three ports on the pig’s left chest. The posterior edges of the 4th, 5th, and 6th intercostal nerves were isolated to the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvests were successfully performed in 40 minutes without major complications. The advantages of robotic microsurgery for intercostal nerve harvesting are motion scaling up to 5 times, elimination of physiological tremors, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvesting for brachial plexus reconstruction.