Chlebanowski B, Wojtowicz BG, Urban K, Kanak M, Domzalski M, Lesman J. Nanoscope-assisted release of the lacertus fibrosus: A cadaveric study of feasibility, visualization, and anatomical safety. World J Orthop 2026; 17(8): 123794 [DOI: 10.5312/wjo.123794]
Corresponding Author of This Article
Jędrzej Lesman, PhD, Academic Fellow, Department of Orthopedy and Trauma, Medical University of Lodz, Turystyczna 6, Lodz 91-615, Poland. jedrzej.lesman@umed.lodz.pl
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Orthopedics
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research-article
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Chlebanowski B, Wojtowicz BG, Urban K, Kanak M, Domzalski M, Lesman J. Nanoscope-assisted release of the lacertus fibrosus: A cadaveric study of feasibility, visualization, and anatomical safety. World J Orthop 2026; 17(8): 123794 [DOI: 10.5312/wjo.123794]
World J Orthop. Aug 18, 2026; 17(8): 123794 Published online Aug 18, 2026. doi: 10.5312/wjo.123794
Nanoscope-assisted release of the lacertus fibrosus: A cadaveric study of feasibility, visualization, and anatomical safety
Bartosz Chlebanowski, Blazej G Wojtowicz, Karolina Urban, Michal Kanak, Marcin Domzalski, Jędrzej Lesman
Bartosz Chlebanowski, Blazej G Wojtowicz, Karolina Urban, Marcin Domzalski, Jędrzej Lesman, Department of Orthopedy and Trauma, Medical University of Lodz, Lodz 90-549, Lodz, Poland
Author contributions: Chlebanowski B, Wojtowicz BG and Lesman J contributed to study conception, cadaveric procedures, and data acquisition; Urban K and Wojtowicz BG contributed to data analysis and manuscript drafting; Domzalski M and Lesman J supervised the study and critically revised the manuscript; and all authors read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using OpenAI ChatGPT solely for language refinement, improvement of clarity, and editorial assistance. All AI-assisted outputs were carefully reviewed, verified, and approved by the authors. AI tools were not used to generate original scientific data, perform statistical analyses, or independently formulate scientific conclusions. The authors take full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of the manuscript and all submitted materials.
Institutional review board statement: The study protocol was reviewed and approved by the Bioethics Committee of the Medical University of Łódź (approval No. RNN/60/25/KE). All cadaveric specimens were obtained and used in accordance with applicable institutional, legal, and ethical requirements.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Jędrzej Lesman, PhD, Academic Fellow, Department of Orthopedy and Trauma, Medical University of Lodz, Turystyczna 6, Lodz 91-615, Poland. jedrzej.lesman@umed.lodz.pl
Received: June 10, 2026 Revised: July 6, 2026 Accepted: August 10, 2026 Published online: August 18, 2026 Processing time: 78 Days and 1.3 Hours
Abstract
BACKGROUND
Compression of the proximal median nerve beneath the lacertus fibrosus is an increasingly recognized cause of activity-related forearm weakness and reduced grip endurance. Surgical decompression is typically performed using open or mini-open techniques. The anatomical feasibility and procedural safety of a minimally invasive nanoscope-assisted release have not been systematically evaluated.
AIM
To evaluate the anatomical feasibility, visualization quality, and procedural safety of nanoscope-assisted lacertus fibrosus release in a cadaveric model, with systematic open dissection used to confirm completeness of release and preservation of adjacent neurovascular structures.
METHODS
Twenty fresh-frozen cadaveric upper limbs underwent lacertus fibrosus release using a 1.9-mm 0° nanoscope system. Feasibility, operative time, and visualization quality were assessed. Visualization of the median nerve, lacertus fibrosus, and brachial artery was independently graded by two surgeons using a 5-point Likert scale. Systematic open dissection was subsequently performed to confirm completeness of release and assess for iatrogenic neurovascular injury.
RESULTS
Nanoscope-assisted release was successfully completed in all 20 specimens without conversion to an open procedure. Mean operative time was 6.9 ± 0.8 minutes. Mean visualization scores were 4.8 ± 0.3 for the median nerve, 4.9 ± 0.1 for the lacertus fibrosus, and 4.6 ± 0.4 for the brachial artery, with good interobserver agreement (intraclass correlation coefficient = 0.88). Open validation confirmed complete release in all specimens, with no residual constricting fibers or visible iatrogenic neurovascular injury.
CONCLUSION
Nanoscope-assisted lacertus fibrosus release was anatomically feasible and demonstrated a favorable procedural safety profile in this cadaveric model. Systematic open validation confirmed complete release and preservation of adjacent neurovascular structures in all specimens. These findings provide an anatomical foundation for prospective clinical evaluation.
Core Tip: Compression of the median nerve beneath the lacertus fibrosus is an increasingly recognized but frequently underdiagnosed cause of proximal median nerve dysfunction. This cadaveric study demonstrates the anatomical feasibility of Nanoscope-assisted lacertus fibrosus release under direct visualization. Systematic post-procedural open dissection confirmed complete release and preservation of adjacent neurovascular structures in all specimens. By combining minimally invasive access with continuous visualization of critical anatomy, the Nanoscope-assisted approach represents a technically viable strategy for proximal median nerve decompression and provides an anatomical foundation for prospective clinical evaluation.
