Initiation of a Robotic Program in Spinal Surgery

Bydon, Mohamad; Chen, Selby G.; Neal, Matthew D.; Krishna, Chandan; Biedermann, Aaron; Paul, Travis; Yolcu, Yagiz U.; Goyal, Anshit; Bendok, Bernard R.; Quiñones‐Hinojosa, Alfredo; Spinner, Robert J.; Meyer, Fredric B.

doi:10.1016/j.mayocp.2020.07.034

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…We postulate that the decreased revision rate, in contrast to studies that have shown increased revision rates, may have been attributable to increased experience with RSS, which may have included the learning curve time period 35 . We hypothesize that with increased RSS experience, both revision rates and operative times may decrease further, as has been suggested by other studies 23,39,40 . Furthermore, costs may be influenced by hospital administration and based on negotiation and the scale of procedures.…”

Section: Methodssupporting

confidence: 63%

“…Various studies have suggested that the learning curve for pedicle screw placement using a robot falls between 20 and 30 cases [43][44][45][46][47] . Studies have also demonstrated that the radiation dose, blood loss, and operative time all decrease with an increasing number of performed cases 23,39,40 . However, as technology advances over time, a state-of-the-art spine robot may appear to be outdated after only a few years, requiring an investment in newer robotic technology and reestablishing the learning curve.…”

Section: Learning Curve and Training Considerationsmentioning

confidence: 99%

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Development of a Robotic Spine Surgery Program

Kuris

Anderson

Osorio

et al. 2022

Journal of Bone and Joint Surgery

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Surgical robots were invented in the 1980s, and since then, robotic-assisted surgery has become commonplace. In the field of spine surgery, robotic assistance is utilized mainly to place pedicle screws, and multiple studies have demonstrated that robots can increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. However, this may be at the cost of longer operative times, complications, and the risk of errors in mapping the patient's anatomy.Obtaining robotic technology for spine surgery often involves administrative hurdles and a high up-front investment. While the financial cost may be recouped through potential cost savings and benefits from marketing, surgeons and staff must first overcome the learning curve with this technology. Once streamlined, robotic spine surgery (RSS) may potentially aid in more complex procedures as its role continues to expand. Advances in computer processing, artificial intelligence, and technological improvements will improve RSS, but it is still critical for surgeons to maintain expertise in traditional surgical techniques as strict dependence on robotic and navigation technology is dangerous.This article provides a brief history of RSS, describes currently available spinal surgery robots, and presents the efficacy, risks, and complications of RSS procedures. It also delineates the cost, reimbursement, learning curve, safety monitoring, and future applications of RSS.Robotic-assisted spine surgery is a rapidly developing technology, and its use is becoming common in practice. Devel-oping a robotic spine surgery (RSS) program faces many challenges, including difficulty obtaining robotic technology, training surgeons and hospital staff, navigating through the learning curve, managing surgeon scheduling of procedures, and monitoring quality and outcomes. Surgeons, practices, and institutions interested in acquiring RSS technology should be aware of the history of robotics in spine surgery, the complications associated with RSS, and the necessary steps for developing a successful RSS program. History and Current Use of Robots in SurgeryIn the early 1980s, robotic surgery was born with investment from the National Aeronautics and Space Administration (NASA) as scientists struggled to solve the problem of providing surgery to astronauts in orbit 1 . In the years following these preliminary experiments, investment flowed to the private sector, and surgeons in operating rooms (ORs) on earth began experimenting with new technologies 2 . In 1989, Computer Motion developed the Automated Endoscopic System for Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H45).

show abstract

Section: Methodssupporting

confidence: 63%

Section: Learning Curve and Training Considerationsmentioning

confidence: 99%

Development of a Robotic Spine Surgery Program

Kuris

Anderson

Osorio

et al. 2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…Another important advantage of robot-assisted spinal surgery illustrated in by our series is the potential for reduced operative time [24][25][26]. Presently, the literature is inconsistent secondary to reports of both reduced and increased operative time with robotassisted spine surgery [12,24,26]. In our series, the operative time per screw -which accounted for time of skin injection to patient transfer off the operating table -was 27.2 minutes.…”

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 81%

“…With revision procedures, these operative times are likely to increase further [6]. Prior research has suggested that operative time for robot-assisted spinal surgeries significantly decreased with time and accrual of surgical experience [24][25][26]. It has thus been argued that once the learning curve is overcome, RAN has a potential to improve operative efficiency.…”

Section: Discussionmentioning

confidence: 99%

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Novel Applications of Robot-Assisted Navigation in the Treatment of Lumbar Adjacent Segment Disease: A Case Series

BS¹,

Lee-Norris²,

Reddy³

2023

Act Scie Neuro

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Objective: The treatment of adjacent segment disease (ASD) following lumbar fusion is common and often requires reoperation.Traditionally, reoperation requires revision and exposure of prior instrumentation, and removal of this hardware increases operative time and perioperative risks. The authors report on the use of robot-assisted navigation (RAN) to accomplish minimally-invasive posterior pedicle screw fixation, including pedicle re-instrumentation when needed, to treat ASD and avoid revision and exposure of prior hardware. Methods:A retrospective review of five patients treated for lumbar ASD with posterior fixation was conducted. All screw trajectories were planned preoperatively using the robotic software. All patients underwent minimally-invasive decompression and transforaminal lumbar interbody fusion followed by robot-assisted pedicle screw placement for fixation. Basic demographics, operative indications, pre-operative planning data, perioperative outcomes and short-term clinical outcomes were evaluated. Results:The mean age was 71.2 years, mean total operative time was 117.6 minutes (range: 98 -140 minutes), mean operative time per screw was 27.2 minutes, mean estimated blood loss was 30mL (range: 25 -50 mL), mean body mass index was 36.64 (range: 26.7 -46.9), and mean length of stay was 1.2 days (range: 1-2 days). A total of six screws were placed in previously instrumented pedicles without removing prior hardware, four in a cortical bone trajectory and two in a transpedicular trajectory (TPT). In one patient with both distal and proximal ASD, pedicle re-instrumentation was avoided altogether, creating a construct caudal, rostral and medial to index fusion. Patients were successfully treated for both single-and multi-level ASD. There were no perioperative complications. One patient was lost to follow-up. The remaining four patients had acceptable outcomes at short-term clinical follow-up. Conclusion:The authors present a novel application of RAN for the treatment of ASD which obviates the need for revision of prior hardware. To our knowledge, this is the first report of multilevel ASD treatment that avoided revision, as well as the first report of pedicle re-instrumentation in a TPT adjacent to a prior transpedicular screw. This method maintained low operative time and acceptable perioperative outcomes. RAN may offer a minimally-invasive and effective treatment option for patients with ASD that avoids revision of prior hardware and reduces perioperative risk. Long-term clinical outcomes are warranted to ensure clinical and biomechanical durability.

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Learning curves in robotic neurosurgery: a systematic review

Shlobin

Huang

2022

Neurosurg Rev

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Initiation of a Robotic Program in Spinal Surgery

Cited by 7 publications

References 19 publications

Development of a Robotic Spine Surgery Program

Development of a Robotic Spine Surgery Program

Novel Applications of Robot-Assisted Navigation in the Treatment of Lumbar Adjacent Segment Disease: A Case Series

Learning curves in robotic neurosurgery: a systematic review

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