J Reconstr Microsurg 2021; 37(06): 503-513
DOI: 10.1055/s-0040-1722183
Original Article

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Mei Goh
2   Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Queensland, Australia
Raymond Goh
3   Valley Plastic Surgery, Queensland, Australia
Yin-Kai Chao
4   Division of Thoracic Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Wen-Ling Kuo
5   Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan
Cheyenne Wei-Hsuan Sung
1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Johnny Chuieng-Yi Lu
1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
David Chwei-Chin Chuang
1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Tommy Nai-Jen Chang
1   Department of Plastic and Reconstructive Surgery, Linkou Medical Center and Chang-Gung University, School of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
› Author Affiliations


Background Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future.

Methods A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared.

Results Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely.

Conclusion Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.

Publication History

Received: 05 June 2020

Accepted: 18 November 2020

Article published online:
05 January 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Felten DL, O'Banion MK, Maida MS. Peripheral Nervous System. In: Felten DL, O'Banion MK, Maida MS. eds. Netter's Atlas of Neuroscience. 3rd ed.. Philadelphia, PA: Elsevier; 2016: 153-231
  • 2 Bouche P. Compression and entrapment neuropathies. In: Said G, Krarup C. eds, Handbook of Clinical Neurology. Elsevier; 2013: 311-366
  • 3 Siao P, Kaku M. A clinician's approach to peripheral neuropathy. Semin Neurol 2019; 39 (05) 519-530
  • 4 Chuang DC. Adult brachial plexus reconstruction with the level of injury: review and personal experience. Plast Reconstr Surg 2009; 124 (Suppl. 06) e359-e369
  • 5 Brunelli GA, Brunelli F, Brunelli GR. Microsurgical reconstruction of sensory skin. Ann Acad Med Singapore 1995; 24 (Suppl. 04) 108-112
  • 6 Koaik M, Baig K. Corneal neurotization. Curr Opin Ophthalmol 2019; 30 (04) 292-298
  • 7 Mucci SJ, Dellon AL. Restoration of lower-lip sensation: neurotization of the mental nerve with the supraclavicular nerve. J Reconstr Microsurg 1997; 13 (03) 151-155
  • 8 Overgoor ML, de Jong TP, Kon M. Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures. Plast Reconstr Surg 2014; 134 (02) 294e-301e
  • 9 Gibbins I. Functional organization of autonomic neural pathways. Organogenesis 2013; 9 (03) 169-175
  • 10 Purves D, Thompson W, Yip JW. Re-innervation of ganglia transplanted to the neck from different levels of the guinea-pig sympathetic chain. J Physiol 1981; 313: 49-63
  • 11 Merculov MV, Golubev IO, Krupatkin AI. New possibilities to increase the results of posttraumatic nerve regeneration with sympathectomy. Zh Nevrol Psikhiatr Im S Korsakova 2015; 115 (07) 68-73
  • 12 Horslen LC, Wilshire CL, Louie BE, Vallières E. Long-term impact of endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. Ann Thorac Surg 2018; 106 (04) 1008-1012
  • 13 Sen I, Agarwal S, Tharyan P, Forster R. Lumbar sympathectomy versus prostanoids for critical limb ischaemia due to non-reconstructable peripheral arterial disease. Cochrane Database Syst Rev 2018; 4: CD009366
  • 14 Telaranta T. Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy. Eur J Surg Suppl 1998; 580 (580) 17-18
  • 15 Chang TN-J, Chen LW-Y, Lee C-P. et al. Microsurgical robotic suturing of sural nerve graft for sympathetic nerve reconstruction: a technical feasibility study. J Thorac Dis 2020; 12 (02) 97-104
  • 16 Philippe A, Liverneaux SHB, Bednar MS. et al. Telemicrosurgery: Robot Assisted Microsurgery. Paris: Springer Verlag; 2013
  • 17 Panchulidze I, Berner S, Mantovani G, Liverneaux P. Is haptic feedback necessary to microsurgical suturing? Comparative study of 9/0 and 10/0 knot tying operated by 24 surgeons. Hand Surg 2011; 16 (01) 1-3
  • 18 Lee SH, Lim S, Kim JH, Lee KY. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 2015; 89 (04) 190-201
  • 19 Selber JC, Can I. Can I make robotic surgery make sense in my practice?. Plast Reconstr Surg 2017; 139 (03) 781e-792e
  • 20 Dobbs TD, Cundy O, Samarendra H, Khan K, Whitaker IS. A systematic review of the role of robotics in plastic and reconstructive surgery-from inception to the future. Front Surg 2017; 4: 66
  • 21 van Mulken TJM, Schols RM, Scharmga AMJ. et al; MicroSurgical Robot Research Group. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial. Nat Commun 2020; 11 (01) 757
  • 22 Taylor GI, Ham FJ. The free vascularized nerve graft. A further experimental and clinical application of microvascular techniques. Plast Reconstr Surg 1976; 57 (04) 413-426
  • 23 Doi K. Distal nerve transfer: perspective of reconstructive microsurgery. J Reconstr Microsurg 2018; 34 (09) 675-677
  • 24 Krishnan KG, Pinzer T, Reber F, Schackert G. Endoscopic exploration of the brachial plexus: technique and topographic anatomy—a study in fresh human cadavers. Neurosurgery 2004; 54 (02) 401-408 , discussion 408–409
  • 25 Miyamoto H, Leechavengvongs S, Atik T, Facca S, Liverneaux P. Nerve transfer to the deltoid muscle using the nerve to the long head of the triceps with the da Vinci robot: six cases. J Reconstr Microsurg 2014; 30 (06) 375-380
  • 26 Mantovani G, Liverneaux P, Garcia Jr JC, Berner SH, Bednar MS, Mohr CJ. Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial. J Neurosurg 2011; 115 (03) 659-664
  • 27 Garcia Jr JC, Lebailly F, Mantovani G, Mendonca LA, Garcia J, Liverneaux P. Telerobotic manipulation of the brachial plexus. J Reconstr Microsurg 2012; 28 (07) 491-494
  • 28 Naito K, Facca S, Lequint T, Liverneaux PA. The Oberlin procedure for restoration of elbow flexion with the da Vinci robot: four cases. Plast Reconstr Surg 2012; 129 (03) 707-711
  • 29 Facca S, Hendriks S, Mantovani G, Selber JC, Liverneaux P. Robot-assisted surgery of the shoulder girdle and brachial plexus. Semin Plast Surg 2014; 28 (01) 39-44
  • 30 Jiang S, Ichihara S, Prunières G. et al. Robot-assisted C7 nerve root transfer from the contralateral healthy side: a preliminary cadaver study. Hand Surg Rehabil 2016; 35 (02) 95-99
  • 31 Bijon C, Chih-Sheng L, Chevallier D, Tran N, Xavier F, Liverneaux P. Endoscopic robot-assisted C7 nerve root retrophalangeal transfer from the contralateral healthy side: a cadaver feasibility study. Ann Chir Plast Esthet 2018; 63 (01) 86-90
  • 32 Lequint T, Naito K, Chaigne D, Facca S, Liverneaux P. Mini-invasive robot-assisted surgery of the brachial plexus: a case of intraneural perineurioma. J Reconstr Microsurg 2012; 28 (07) 473-476
  • 33 Tigan L, Miyamoto H, Hendriks S, Facca S, Liverneaux P. Interest of telemicrosurgery in peripheral nerve tumors: about a series of seven cases. Chir Main 2014; 33 (01) 13-16
  • 34 Garcia Jr JC, de Souza Montero EF. Endoscopic robotic decompression of the ulnar nerve at the elbow. Arthrosc Tech 2014; 3 (03) e383-e387
  • 35 Miyamoto H, Serradori T, Mikami Y. et al. Robotic intercostal nerve harvest: a feasibility study in a pig model. J Neurosurg 2016; 124 (01) 264-268
  • 36 Kovachevich R, Kircher MF, Wood CM, Spinner RJ, Bishop AT, Shin AY. Complications of intercostal nerve transfer for brachial plexus reconstruction. J Hand Surg Am 2010; 35 (12) 1995-2000
  • 37 Pondaag W, Malessy MJ. Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions. J Hand Surg Eur Vol 2014; 39 (06) 647-652
  • 38 Porto de Melo P, Miyamoto H, Serradori T. et al. Robotic phrenic nerve harvest: a feasibility study in a pig model. Chir Main 2014; 33 (05) 356-360
  • 39 Connery CP. Reconstruction of the sympathetic chain. Thorac Surg Clin 2016; 26 (04) 427-434
  • 40 Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg 2014; 147 (04) 1160-1163.e1
  • 41 Lee MR, Lee GI. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons? A comprehensive ergonomics survey study in gynecologic robotic surgery. J Gynecol Oncol 2017; 28 (05) e70
  • 42 Tan YPA, Liverneaux P, Wong JKF. Current limitations of surgical robotics in reconstructive plastic microsurgery. Front Surg 2018; 5: 22
  • 43 Chuang DC. Distal nerve transfers: a perspective on the future of reconstructive microsurgery. J Reconstr Microsurg 2018; 34 (09) 669-671
  • 44 Mackinnon SE. Future perspectives in the management of nerve injuries. J Reconstr Microsurg 2018; 34 (09) 672-674
  • 45 Porreca A, D'Agostino D, Dente D. et al. Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes. Int Braz J Urol 2018; 44 (01) 63-68
  • 46 Tselos A, Moris D, Tsilimigras DI. et al. Robot-assisted retroperitoneal lymphadenectomy in testicular cancer treatment: a systematic review. J Laparoendosc Adv Surg Tech A 2018; 28 (06) 682-689
  • 47 Porto de Melo PM, Garcia JC, Montero EF. et al. Feasibility of an endoscopic approach to the axillary nerve and the nerve to the long head of the triceps brachii with the help of the Da Vinci Robot. Chir Main 2013; 32 (04) 206-209
  • 48 Nectoux E, Taleb C, Liverneaux P. Nerve repair in telemicrosurgery: an experimental study. J Reconstr Microsurg 2009; 25 (04) 261-265
  • 49 Garcia Jr JC, Mantovani G, Gouzou S, Liveneaux P. Telerobotic anterior translocation of the ulnar nerve. J Robot Surg 2011; 5 (02) 153-156
  • 50 Latif MJ, Afthinos JN, Connery CP. et al. Robotic intercostal nerve graft for reversal of thoracic sympathectomy: a large animal feasibility model. Int J Med Robot 2008; 4 (03) 258-262