Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Abstract

Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of computed tomography and magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical levels through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

“…The results also showed no significant differences among the two technical methods in postoperative sensory abnormalities, disc recurrence, or other complications. Some scholars [ 29 ] believe that percutaneous spinal endoscopic technology after percutaneous puncture positioning casing and endoscopy directly by the foraminal area into the spinal canal and in the circulating water environment avoid large incision exposure, and timely debris, intraoperative bleeding point in the intraoperative area clearly visible, plasma bipolar radiofrequency hemostasis, and various conditions reduce the surgical area wound complications [ 30 ].…”

Navigation Techniques in Endoscopic Spine Surgery

“…A growing body of evidence suggests electromagnetic navigation, which requires only a pair of fluoroscopy images at the start of the registration process, can dramatically reduce irradiation for the staff and for the patient, as well as the number of puncture trials needed to position the working channel perfectly [ 25 , 55 ]. Navigation of the entry needle has also been associated with a flattening of the beginner's learning curve for the tPELS technique [ 8 ].…”

“…The use of navigation may allow for easier adoption by trainees who will likely use ESS in their future practices given its growing popularity and range of indications [ 1 , 7 ]. In addition, for tPELS, optimal positioning of the working channel is crucial to avoid operative complications such as injury to the exiting nerve root or blood vessels and to treat foraminal stenosis or herniated discs effectively [ 8 ]. Radiation dose can increase dramatically for the patient and the medical staff when multiple fluoroscopies are needed to obtain optimal positioning of the working channel [ 8 ].…”

“…In addition, for tPELS, optimal positioning of the working channel is crucial to avoid operative complications such as injury to the exiting nerve root or blood vessels and to treat foraminal stenosis or herniated discs effectively [ 8 ]. Radiation dose can increase dramatically for the patient and the medical staff when multiple fluoroscopies are needed to obtain optimal positioning of the working channel [ 8 ]. For these reasons, more recently developed intraoperative navigation techniques have been readily applied to ESS.…”

Diffusion‐Weighted Imaging Combined with Perfusion‐Weighted Imaging under Segmentation Algorithm in the Diagnosis of Melanoma

“…In image processing, there are countless algorithms that can be applied for segmentation. The earliest method used for automatic segmentation of cerebral tumor is traditional machine learning, in which the threshold algorithm, clustering algorithm, and deformation mode algorithm are more commonly used than other machine learning algorithms [ 13 , 14 ]. Automatic brain tumor segmentation technology has been a hot research topic in recent years, especially that based on multimodal three-dimensional (3D) image segmentation.…”