Advantages in precision, safety, and aesthetic outcomes of robot-assisted minimally invasive techniques in peripheral nerve microsurgery: a narrative review

Traditional open surgery for treating peripheral nerve disorders often leads to considerable trauma, scarring, and complications. However, with the ongoing advancements in microsurgical techniques, robotic-assisted minimally invasive surgery has emerged as a promising approach in the field of peripheral nerve disorder treatment. It combines innovative access techniques, such as the creation of artificial subcutaneous cavities, with telemanipulated instruments, enabling highly precise neurolysis, suturing, and grafting. Through incisions of less than 1 cm and enhanced three-dimensional visualization facilitated by CO₂ insufflation, these procedures ensure superior visibility while minimizing tissue trauma. The clinical applications of this technology are diverse. For instance, neurolysis of the lateral cutaneous nerve of the thigh has shown promising results in the treatment of meralgia paresthetica, while experiments on the median nerve and ulnar nerve transposition highlight its potential for complex interventions. Techniques such as contralateral C7 root transfer or endoscopic repair of the brachial plexus further demonstrate that robotics can address the challenges of highly demanding pathologies, offering superior aesthetic and functional outcomes. Despite these advances, technological challenges remain, particularly in creating stable operative spaces and managing CO₂ leakage. Additionally, the high cost of robotic systems limits their accessibility. To validate and generalize these techniques, large-scale clinical studies are needed. Furthermore, innovations such as augmented reality and artificial intelligence could further optimize these approaches. In conclusion, robot-assisted surgery of peripheral nerves provides significant benefits in terms of precision, safety, and aesthetic outcomes. With continued developments, it has the potential to redefine the standards of nerve surgery and transform the management of complex nerve lesions.

中文摘要

传统开放手术在治疗周围神经疾病时，常伴随较大创伤、疤痕和并发症。随着显微手术技术的不断发展，机器人辅助下的微创手术在周围神经治疗领域展现出巨大潜力。机器人辅助周围神经微创手术将创新的入路技术（如创建人工皮下腔）与远程操控器械相结合，实现了异常精确的神经切除、缝合和移植。通过小于1 cm的切口和二氧化碳充气增强的三维可视性，这些手术确保了卓越的可视性，同时最大限度地减少了组织创伤。此综述的目的是阐述机器人辅助微创手术在周围神经治疗中的应用进展、手术技术的精确性、安全性和美学效果的优势。周围神经显微手术中的机器人辅助微创技术的临床应用多种多样。例如，大腿外侧皮神经的神经溶解术在治疗麻痹症方面取得了可喜的成果，而正中神经和尺神经转位实验则凸显了该技术在复杂干预方面的潜力。对侧C7 神经根转移或臂丛内窥镜修复等技术进一步证明，机器人技术可以应对高难度病症的挑战，提供卓越的美学和功能效果。尽管机器人辅助微创技术取得了这些进步，但技术挑战依然存在，特别是在创建稳定的手术空间和管理二氧化碳渗漏方面。此外，机器人系统的高成本也限制了其普及。为了验证和推广机器人辅助微创技术，未来需要进行大规模的临床研究。此外，增强现实和人工智能等创新技术可进一步优化这些方法。总之，机器人辅助周围神经手术在精确性、安全性和美学效果方面具有显著优势。随着不断发展，它有可能重新定义神经手术的标准，并改变复杂神经病变的治疗方法。