[Bionic Surgery Meets Bionic Reconstruction - First In-human use of Robotic Microsurgery in Targeted Muscle Reinnervation]. / Bionische Chirurgie trifft Bionische Rekonstruktion ­ erstes in-human Projekt von robotischer Mikrochirurgie zur Targeted Muscle Reinnervation.

Robotic microsurgery is an emerging field in reconstructive surgery, which provides benefits such as improved precision, optimal ergonomics, and reduced tremors. However, only a few robotic platforms are available for performing microsurgical procedures, and successful nerve coaptation is still a challenge. Targeted muscle reinnervation (TMR) is an innovative reconstructive procedure that rewires multiple nerves to remnant stump muscles, thereby reducing neuroma and phantom limb pain and improving the control of bionic prostheses. The precision of surgical techniques is critical in reducing axonal sprouting around the coaptation site to minimise the potential for neuroma formation. This study reports the first use of a microsurgical robotic platform for multiple nerve transfers in a patient undergoing TMR for bionic extremity reconstruction. The Symani robotic platform, combined with external microscope magnification, was successfully used, and precise handling of nerve tissue and coaptation was easily feasible even in anatomically challenging environments. While the precision and stability offered by robotic assistance may be especially useful for nerve surgery, the high economic costs of robotic microsurgery remain a major challenge for current healthcare systems. In conclusion, this study demonstrated the feasibility of using a robotic microsurgical platform for nerve surgery and transfers, where precise handling of tissue is crucial and limited space is available. Future studies will explore the full potential of robotic microsurgery in the future.

[Nerve Transfers in Peripheral Nerve Lesions]. / Nerventransfers bei peripheren Nervenläsionen.

BACKGROUND: Lesions of peripheral nerves of the upper extremities often lead to persistent, serious limitations in motor function and sensory perception. Affected patients suffer from both private and professional restrictions associated with long-term physical, psychological and socioeconomic consequences. INDICATION: An early indication for a nerve transfer shortens the reinnervation distance and improves the growing of motor and sensory axons into the target organ to facilitate early mobility and sensitivity. When planning the timepoint of the surgical procedure, the distance to be covered by reinnervation as well as the morbidities of donor nerves must be considered individually. RESULTS: Nerve transfers can achieve earlier and safer reinnervation to improve motor and sensory functions after nerve injuries in the upper extremity.

[Differential therapeutic Approaches in Treatment of Carpal Tunnel Syndrome]. / Differentialtherapeutische Herangehensweisen zur Behandlung des Karpaltunnelsyndroms.

Carpal tunnel syndrome (CTS) is one of the most common compression neuropathies. The therapeutic concept should be tailored to each patient individually, with initial non-surgical treatment being the standard of care for early CTS. Primary surgical intervention should be considered in more advanced diseases stages, in case of concomitant pathologies (including space-occupying lesions, complex regional pain syndrome or diabetic neuropathy), if non-surgical strategies have failed or in pregnancy-related CTS. This work aims to discuss common surgical approaches, their clinical application as well as benefits and disadvantages in a pragmatic style. Further, we highlight surgical strategies to address recurrent CTS following failed primary surgery. In view of the recently updated S3 guidelines "Diagnosis and Therapy of Carpal Tunnel Syndrome", this topic is timely and relevant for hand and nerve surgeons.

[Improved diagnostics and therapeutic decision making in traumatic peripheral nerve lesions using MR-neurography]. / Gezielte Therapieplanung bei traumatischen Nervenläsionen mittels MR-Neurographie.

INTRODUCTION: The correct diagnosis of peripheral nerve injuries is essential for choosing the correct treatment in nerve surgery. Especially, nerve defects require early diagnosis to provide quick surgical reconstruction and prevent long-term disabilities. Recent developments in MR-neurography provide surgeons with a diagnostic tool delivering precise information on the structure and possibly function of nerves. Here we describe a series of cases, that benefited from preoperative MR-neurography to identify the correct type of injury. MATERIAL AND METHODS: We demonstrate five traumatic nerve injuries which were evaluated using high-resolution MR-neurography imaging for therapeutic planning, combined with standard clinical, electrophysiological and sonography diagnostics. We show the clinical feasibility, benefit of this new technique for nerve surgery and the correlation of preoperative MR-neurography images to the intraoperative situation (in surgically managed cases). RESULTS: Two cases were successfully treated without surgery based on the intact nerve-integrity found in the MR-neurography, despite pathological electrophysiology and inconclusive sonography. In three cases, the MR-Neurography enabled a precise diagnosis and localization of the nerve lesion. Thereby, a precise surgical reconstruction of the nerve lesion was achieved, confirming the matching of MR-neurography findings and intraoperative situs. DISCUSSION: Although, systematic clinical analyses are not available yet, our data suggest that MR-neurography can help surgeons to correctly define the type of nerve injury and thus identify the appropriate treatment preoperatively. In the presented cases, MR-neurography correctly diagnosed the type of injury and therefore allowed adequate planning and decision making between non-surgical treatment, neurolysis or nerve reconstruction. We believe that MR-neurography is an emerging tool for nerve surgeons to improve the treatment of nerve injuries. CONCLUSION: MR-neurography delivers decisive information on the nerve lesion and helps to identify the necessity to operate and the correct surgical treatment.