How a robotic visualization system can facilitate targeted muscle reinnervation

Background:To enable and further improve microsurgical outcomes, different loupes and optic based microscopes have been proposed in recent years. In amputation surgery continuous progress and prosthetic developments have provided amputees with improved degree of function and quality of life.We present a 17-year-old patient who suffered traumatic loss of the left upper limb and underwent TMR-surgery facilitated by a 3D-robotic-exoscope-system. Methods:The rerouting of the distal ends of the arm-nerves (Targeted Muscle Reinnervation) was performed in the upper limb of a traumatic transhumeral amputee patient using 3D-robotic-exoscope-system (RS, RoboticScope). Perioperative data was collected and compared to standard. Users’ evaluation of the system during the surgical procedure was done using a 5-point-Likert-Scale. Results:Operation time was 311 minutes, the robotic system was used for 101 minutes. Overall users´ evaluation revealed 4,5 for selected items on the Likert-Scale. The evaluation showed similar results in evaluation of the system by main and assistant surgeons. No special training was required beforehand. The bimanual control allowed for improved personal freedom in the surgical field at a comfortable position. The imaging of colors will need future improvements until authentic representation of in situ structures is achieved. Conclusions:Major advantages of a robotic Scope-3D-exoscope-system are improved image quality, ergonomic position, and increased accessibility in a wider operating field due to system implied features. Another benefit is digital documentation, simultaneous education through possibility of capturing images and videos and easy transportation between operating rooms without risk to harm the vulnerable optic. Digital microscopes are still not yet implemented as standard of care.