Figures & data
Figure 1. Angio-MRI showing the lack of permeability of the ulnar artery at the level of the tunnel of Guyon.
Figure 2. Installation of the da Vinci S® robot. (a) The patient cart is fitted with a sterile cover and is located opposite the conventional surgeon's position. The robot arms are obliquely directed in such a way that the instruments are placed in the same direction as those of a conventional operator. No operative assistance is necessary. (b) The surgeon's console is placed several meters distant from the patient, on the anesthetist's side. The surgeon handles the instruments remotely, without sterile clothing. His head is placed inside the safety system which allows the release of the instruments.
Figure 3. The operating surgeon's view of the procedure on the control screens. The operative field corresponds to the distal anastomosis of the inverted venous graft (at right) with the distal end of the ulnar artery (at left). The vascular clamp is maintained by Pott scissors (at top). (a) The Black Diamond forceps on the right exerts a slight pressure on the wall of the venous graft to facilitate passing the needle and nylon 10/0 thread through the lumen of the ulnar artery distal end with the other Black Diamond forceps on the left. (b) The forceps on the right is about to grab the end of the needle which is still held by the left forceps. (c) The forceps on the left regains its hold on the end of the needle before knot tightening. (d) Once the anastomosis is achieved, the left forceps exerts some pressure on the clamp to release the distal end of the ulnar artery. The right forceps exerts a slight pressure on the venous graft wall to facilitate clamp removal.
