{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T18:52:29Z","timestamp":1790535149315,"version":"4.1.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The aim of this paper was to develop an effective minimally invasive approach to brachial plexus surgery and to determine the feasibility of using telerobotic manipulation to perform a diagnostic dissection and microsurgical repair of the brachial plexus utilizing an entirely endoscopic approach.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed an endoscopic approach using 3 supraclavicular portals in 2 fresh human cadaver brachial plexuses with the aid of the da Vinci telemanipulation system. Dissection was facilitated inflating the area with CO<jats:sub>2<\/jats:sub> at 4 mm Hg pressure. The normal supraclavicular plexus was dissected in its entirety to confirm the feasibility of a complete supraclavicular brachial plexus diagnostic exploration. Subsequently, an artificial lesion to the upper trunk was created, and nerve graft reconstruction was performed. Images and video of the entire procedure were obtained and edited to illustrate the technique.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>All supraclavicular structures of the brachial plexus could be safely dissected and identified, similar to the experience in open surgery. The reconstruction of the upper trunk with nerve graft was successfully completed using an epineural microsurgical suture technique performed exclusively with the aid of the robot. There were no instances of inadvertent macroscopic damage to the vascular and nervous structures involved.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>An endoscopic approach to the brachial plexus is feasible. The use of the robot makes it possible to perform microsurgical procedures in a very small space with telemanipulation and minimally invasive techniques. The ability to perform a minimally invasive procedure to explore and repair a brachial plexus injury may provide a new option in the acute management of these injuries.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.3.jns10931","type":"journal-article","created":{"date-parts":[[2011,4,8]],"date-time":"2011-04-08T16:28:48Z","timestamp":1302280128000},"page":"659-664","source":"Crossref","is-referenced-by-count":37,"title":["Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial"],"prefix":"10.3171","volume":"115","author":[{"given":"Gustavo","family":"Mantovani","sequence":"first","affiliation":[{"name":"Department of Hand Surgery, \u201cBenefic\u00eancia Portuguesa de S\u00e3o Paulo\u201d Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Liverneaux","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Strasbourg University Hospitals, Illkirch, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Carlos","family":"Garcia","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Pontifical Catholic University of Campinas, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey H.","family":"Berner","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Sinai Hospital of Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Bednar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Loyola University, Maywood, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine J.","family":"Mohr","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns10931","series-title":"J Reconstr Microsurg","first-page":"539","article-title":"Endoscopic exploration of a brachial plexus injury","volume":"22","author":"Braga-Silva","year":"2006"},{"issue":"3 Suppl","key":"b2-jns10931","series-title":"J Neurosurg","first-page":"277","article-title":"Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography","volume":"96","author":"Doi","year":"2002"},{"key":"b3-jns10931","series-title":"J Hand Surg Br","first-page":"550","article-title":"The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus","volume":"24","author":"Hems","year":"1999"},{"key":"b4-jns10931","series-title":"Neurosurgery","first-page":"401","article-title":"Endoscopic exploration of the brachial plexus: technique and topographic anatomy\u2014a study in fresh human cadavers","volume":"54","author":"Krishnan","year":"2004"},{"key":"b5-jns10931","series-title":"Ann R Coll Surg Engl","first-page":"470","article-title":"Value of the Tinel sign in brachial plexus lesions","volume":"61","author":"Landi","year":"1979"},{"key":"b6-jns10931","series-title":"J Bone Joint Surg Br","first-page":"492","article-title":"The role of somatosensory evoked potentials and nerve conduction studies in the surgical management of brachial plexus injuries","volume":"62-B","author":"Landi","year":"1980"},{"key":"b7-jns10931","series-title":"J Hand Surg Am","first-page":"367","article-title":"Surgical management of brachial plexus injuries","volume":"2","author":"Millesi","year":"1977"},{"key":"b8-jns10931","series-title":"J Hand Surg Br","first-page":"547","article-title":"The endoscopic diagnosis and possible treatment of nerve root avulsions in the management of brachial plexus injuries","volume":"19","author":"Monsivais","year":"1994"},{"key":"b9-jns10931","series-title":"Clin Orthop Relat Res","first-page":"71","article-title":"Surgical treatment of traction injuries of the brachial plexus","volume":"133","author":"Narakas","year":"1978"},{"key":"b10-jns10931","series-title":"Int Orthop","first-page":"29","article-title":"The treatment of brachial plexus injuries","volume":"9","author":"Narakas","year":"1985"},{"key":"b11-jns10931","series-title":"J Reconstr Microsurg","first-page":"261","article-title":"Nerve repair in telemicrosurgery: an experimental study","volume":"25","author":"Nectoux","year":"2009"},{"key":"b12-jns10931","series-title":"Curr Sports Med Rep","first-page":"240","article-title":"Diagnosis and management of thoracic outlet syndrome","volume":"8","author":"Nichols","year":"2009"},{"key":"b13-jns10931","series-title":"Clin Orthop Relat Res","first-page":"4","article-title":"Brachial plexus paralysis. 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Stevens, M.D., 1934","volume":"237","author":"Stevens","year":"1988"},{"key":"b14-jns10931","series-title":"Microsurgery","first-page":"232","article-title":"Limb replantation with two robots: a feasibility study in a pig model","volume":"29","author":"Taleb","year":"2009"},{"key":"b15-jns10931","series-title":"Chir Main","first-page":"104","article-title":"Telemicrosurgery: a feasibility study in a rat model","volume":"27","author":"Taleb","year":"2008"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/3\/article-p659.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/3\/article-p659.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/3\/article-p659.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:20:48Z","timestamp":1679883648000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/3\/article-p659.xml"}},"subtitle":["Laboratory investigation"],"short-title":[],"issued":{"date-parts":[[2011,9]]},"references-count":15,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2011.3.jns10931","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,9]]}}}