Intercostal nerves harvesting through thoracoscopy without da Vinci™ robot
Epublication WebSurg.com, May 2014;14(05). URL: http://websurg.com/doi/lt03enmikami001
Intercostal nerve transfer is useful in brachial plexus surgery, especially for the restoration of elbow flexion. Freeing of intercostal nerves for nerve transfer, however, requires a long skin incision and can result in damage to the muscles and ribs. Video-assisted thoracoscopic surgery (VATS) has been developed recently as a diagnostic and therapeutic technique for intrathoracic organ diseases. Intercostal nerve transfer to the musculocutaneous nerve (MCN) using the VATS system has been performed in eight patients with brachial plexus injuries. Eight patients (seven males, one female, 17-32 y.o.) underwent intercostal nerve transfer to the MCN using the VATS system between 2005 and 2012. Two patients were converted from thoracoscopic surgery to open surgery. Power of the biceps was recovered to M3 or more in five out of seven patients, who were followed for more than two years postoperatively. No respiratory complications occurred. Although this technique is challenging, the da Vinci® system will make the procedure easier and improve its accuracy and safety.