Supercharge end-to-side anterior interosseous to motor ulnar nerve transfer under robotic exoscopic visualization: Proof-of-concept illustrative case

Herein, we report the first case of a supercharge end-to-side anterior interosseous to motor ulnar nerve transfer performed under exoscopic visualization, providing new insights that may help better define the role of high-definition robotic exoscopes in nerve transfer. The rationale for this procedure was based on the poor outcomes associated with nerve decompression at the elbow in cases of severe cubital tunnel syndrome. The end-to-side anterior interosseous to motor ulnar nerve transfer can promote reinnervation of the intrinsic muscles of the hand through both direct donor axon reinnervation and regeneration of native axons. In presenting this illustrative case, we observed specific benefits that the exoscope (Modus X, Synaptive, Canada) offers for this nerve transfer procedure: it facilitates identification and neurolysis of the motor fascicle bundle of the ulnar nerve; it allows rapid switching between micro and macro visualization and during microsuturing, it eliminates the need for frequent zoom and focus adjustments required by the microscope. Further studies are needed to clarify the benefits of the exoscope compared to established visualization tools and to determine the surgical settings in which it is best indicated.