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

摘要

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 C 7 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.