Learning Curve for Robot-Assisted Percutaneous Pedicle Screw Placement in Thoracolumbar Surgery

Abstract

Study DesignRetrospective review of an initial cohort of consecutive patients undergoing robot-assisted pedicle screw placement.PurposeWe aimed to evaluate the learning curve, if any, of this new technology over the course of our experience.Overview of LiteraturePercutaneous pedicle screws have specific advantages over open freehand screws. However, they require intraoperative imaging for their placement (e.g., fluoroscopy and navigation) and require increased surgeon training and skill with the learning curve estimated at approximately 20–30 cases. To our knowledge, this is the first study that measures the learning curve of robot-guided purely percutaneous pedicle screw placement with comprehensive objective postoperative computed tomography (CT) scoring, time per screw placement, and fluoroscopy time.MethodsWe included the first 80 consecutive patients undergoing robot-assisted spinal surgery at Melbourne Private Hospital. Data were collected for pedicle screw placement accuracy, placement time, fluoroscopy time, and revision rate. Patient demographic and relevant perioperative and procedural data were also collected. The patients were divided equally into four sub-groups as per their chronological date of surgery to evaluate how the learning curve affected screw placement outcomes.ResultsTotal 80 patients were included; 73 (91%) had complete data and postoperative CT imaging that could help assess that placement of 352 thoracolumbar pedicle screws. The rate of clinically acceptable screw placement was high (96.6%, 95.4%, 95.6%, and 90.7%, in groups 1 to 4, respectively, p=0.314) over time. The median time per screw was 7.0 minutes (6.5, 7.0, 6.0, and 6.0 minutes in groups 1 to 4, respectively, p=0.605). Intraoperative revision occurred in only 1 of the 352 screws (0.3%).Conclusions We found that robot-assisted screw placement had high accuracy, low placement time, low fluoroscopy time, and a low complication rate. However, there were no significant differences in these parameters at the initial experience and the practiced, experience placement (after approximately 1 year), indicating that robot-assisted pedicle screw placement has a very short (almost no) learning curve.

Robot‐assisted percutaneous vertebroplasty under local anaesthesia for osteoporotic vertebral compression fractures: a retrospective, clinical, non‐randomized, controlled study

“…Each surgeon's learning curve of percutaneous minimally invasive puncture technology and robot‐assisted puncture might have affected the experimental data 17–19 ,. 22–26 The longest follow‐up time was 3 months after the surgery in this study. Hence, longer follow‐up time was needed to explore the factors influencing the results.…”

“… 24 The surgeon should understand the characteristics of the robot system and master its operation process, including learning to effectively integrate the robot operating system into the entire surgical process. Previous studies have reported 25 , 26 that the learning curve of robot‐assisted puncture screw insertion is in the range of 20–50 surgeries. At least 25 surgeries must be completed to acquire proficiency in this technique.…”

“…used surgical efficiency as an average indicator of proficiency in robot‐assisted puncture screw insertion and believed that the completion of the learning curve needed the completion of more than 30 surgeries. Kam et al 26 . comprehensively analysed the learning curve of robot‐assisted pedicle screw insertion by evaluating the accuracy of screw insertion, completion time of screw insertion, radiation exposure time and complication rate.…”

Safety and Risk Factors of Tinavi Robot-assisted Percutaneous Pedicle Screw Placement in Spinal Surgery

“…Previous studies reported that the surgical outcomes from the initial experience to practiced experience showed no remarkable difference. [27,28] Thus, surgical skills are relatively less demanding, thereby indicating that RA technique may prevent malposition by reducing unnecessary manual mistakes. Fifth, due to the precise insertion of RA technique, the rate of medial penetrations was greatly reduced, avoiding the relevant severe complications, such as spinal cord and nerve root injuries.…”

The current state of navigation in robotic spine surgery

“…Studies have shown little difference between novice and experienced surgeons with respect to procedural efficiency in placing robotically guided pedicle screws; despite this, a trend towards increasing efficiency after the performance of a certain number of cases or placement of a certain number of screws placed has been reported (45,46). The only study in a full navigation enabled robotic platform that comments on learning curve showed no difference between the attending and the first participating fellow.…”