Oberlin's procedure for restoration of elbow flexion with a da Vinci® robot
Epublication WebSurg.com, Mar 2014;14(03). URL: http://websurg.com/doi/lt03ennaito001
Robotics allow visual magnification up to 40 times, and a 10 time-magnification of the surgeon’s movements, as well as the elimination of physiological tremors. These properties should allow for the development of minimally invasive limb surgery, especially brachial plexus surgery. The purpose of this work was to test the feasibility of elbow flexion restoration according to the technique of Oberlin using a da Vinci® robot. Our series included 4 patients (mean age: 31 years) presenting with elbow flexion paralysis. They were operated on 8 months after injury using a da Vinci S® robot. In three patients, the open technique (technique 1) was used, and the minimally invasive approach (technique 2) was used for the last one. Strength of elbow flexion was measured. After 1 year of follow-up, all patients recovered elbow flexion. No sensory nor motor deficit was found in the ulnar nerve territory. There was no difficulty with technique 1; technique 2, however, required a conversion to technique 1 due to the difficulty in visualizing the operative field. The results of our series show the feasibility of the robot-assisted technique for the Oberlin procedure. The lack of sensory feedback was not an issue. The development of specific retractors and instruments should improve the minimally invasive technique.