A minimally invasive method of endoscopy-assisted sural nerve (SN) harvest
in infants with obstetric brachial plexus lesions requiring nerve grafting
procedures was applied to reduce the skin incision size and scarring at the
donor site. Endoscopic visualization was achieved using a flexible and ste
erable Neuroview neuronavigational endoscope (Promedics, NL) 2.3 mm in diam
eter and 12 or 18 cm long in a peelaway sheath (700-9F) attached to a video
camera. Through three 1.5-cm skin incisions the SN could be dissected free
using a 2.5-mm-diameter nerve stripper, pituitary curette or pituitary sci
ssors under endoscopic vision from the opposite direction. To prevent any c
entral nociceptive pain behavior the sural nerve was blocked by lidocaine,
and sectioned first proximally in the popliteal fossa then distally at the
lateral malleolus.