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In order to re-evaluate the safest area to incise skin and the flexor retinaculum (FR) when performing a carpal tunnel release (CTR), we carried out a mapping study of the nerve endings in the skin and FR on cadaver specimens, which, unlike previous studies for the first time, includes histomorphometry and image digital analysis. After dividing the skin and FR into 20 and 12 sections, respectively, we carried out a histomorphological analysis of nerve endings. The analysis was performed by two neutral observers on 4-μm histological sections stained with hematoxylin-eosin (H-E), and Klüver-Barrera with picrosirius red (KB + PR) methods. A semi-automatic image digital analysis was also used to estimate the percentage of area occupied per nerve. We observed a lower quantity of nerve endings in the skin of the palm of the hand in line with the ulnar aspect of the 4th finger. The ulnar aspect of the FR was the most densely innervated. However, there are no statistically significant differences between sections in the percentage of area occupied per nerve both in the skin and in the FR. We concluded that there is not a safe area to incise when performing carpal tunnel surgery, but taking into account the quantity of nerve endings present in skin and FR, we recommend an incision on the axis of the ulnar aspect of 4th finger when incising skin and on the middle third of the FR for CTR.

Resumen Introduccion El papel de la cirugia robotica esta claramente establecido en diversas especialidades como Urologia o Cirugia General, pero no asi en otras como Neurocirugia u Otorrinolaringologia, y en el caso concreto de la Cirugia de base de craneo, apenas ha pasado de una fase experimental. Objetivo Investigar las posibilidades de la aplicacion del robot quirurgico da Vinci en cirugia transoral de base de craneo comparandola con la experiencia de los autores en cirugia endoscopica transnasal convencional de la misma region. Metodos se llevo a cabo un abordaje transoral transpalatino a la rinofaringe y la base del craneo medial en 4 cabezas de cadaver criopreservadas. Se empleo el robot da Vinci, con endoscopio de 30° y 12 mm de grosor, con doble camara e iluminacion doble, pinza de Maryland en el terminal izquierdo y tijera curva en el derecho, ambos de 8 mm de grosor. El fresado oseo se realizo manualmente. Para el estudio anatomico de la region a abordar se emplearon cortes axiales de 0,5 cm de grosor de una cabeza de cadaver plastinada. Resultados Con los terminales del robot se alcanzaron con relativa facilidad diversas estructuras de la base del craneo a distintos niveles de profundidad. Conclusiones La cirugia robotica transoral con el sistema da Vinci aporta posibles ventajas sobre la cirugia endoscopica transnasal convencional en el abordaje quirurgico de esta region

The role of robotic surgery is well established in various specialties such as urology and general surgery, but not in others such as neurosurgery and otolaryngology. In the case of surgery of the skull base, it has just emerged from an experimental phase.To investigate possible applications of the da Vinci surgical robot in transoral skull base surgery, comparing it with the authors' experience using conventional endoscopic transnasal surgery in the same region.A transoral transpalatal approach to the nasopharynx and medial skull base was performed on 4 cryopreserved cadaver heads. We used the da Vinci robot, a 30° standard endoscope 12mm thick, dual camera and dual illumination, Maryland forceps on the left terminal and curved scissors on the right, both 8mm thick. Bone drilling was performed manually. For the anatomical study of this region, we used 0.5cm axial slices from a plastinated cadaver head.Various skull base structures at different depths were reached with relative ease with the robot terminalsTransoral robotic surgery with the da Vinci system provides potential advantages over conventional endoscopic transnasal surgery in the surgical approach to this region.