Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement

Abstract

Objective: The study investigated our institutional learning curve for the ROSA ONE spine system (ROSA) based on ROSA usage time.Methods: ROSA was designed to provide high accuracy for spinal pedicle screw placement through a built-in tracking technique. This study was conducted from November 2018 to January 2021. The time taken to complete each step of the robotic workflow was recorded. Patient demographics, comorbidities, surgical indications, and number of screw placements were examined in subgroup analysis. The Curve Fitting-General package (a part of NCSS 2021 software) was used to fit a mathematical model to the learning curve. Patient demographics, imaging data, and surgical time were reviewed retrospectively.Results: A total of 167 patients who had undergone surgery were included. The mean total ROSA usage time was 107.1 ± 27.3 minutes. The estimated learning rate was 90.4%, and the largest slope change occurred close to the time of the 20th surgery. The observed overall learning trend in the 4-screw group could be attributed to screw planning. The presence of scoliosis (p = 0.73) or spondylolisthesis (p = 0.70) did not significantly influence the mean total time (TT) for all patients; however, the mean TT differed significantly (p < 0.01) among subgroups stratified by body mass index, screw number placement, and thoracic spine involvement.Conclusion: To the best of our knowledge, this is the first study to examine the learning curve for the various crucial steps of ROSA-guided pedicle screw placement. The indicative learning curve involved 20 patients who had undergone surgery.

Spine Surgical Robotics: Current Status and Recent Clinical Applications

“…(5) Learning curve: Several studies have shown that the length of learning curve for RA spine surgery varies due to the use of different robotic systems. [101][102][103][104] The learning curve was determined by a variety of factors, including total time, screw insertion time, screw accuracy and number of cases required to complete the learning phase. Clinicians who first use robotic systems can pass the learning stage after completing approximately 20-30 surgeries, while clinically experienced clinicians only need 17-20 cases to pass this stage.…”

“…(5) Learning curve: Several studies have shown that the length of learning curve for RA spine surgery varies due to the use of different robotic systems [ 101 - 104 ]. The learning curve was determined by a variety of factors, including total time, screw insertion time, screw accuracy and number of cases required to complete the learning phase.…”

Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study

“…5,[9][10][11][12] Various robotic systems for spine surgery have been developed and tested including SpineAssist, Renaissance, Mazor X (Mazor Robotics Inc., Caesarea, Israel), Mazor X Stealth Edition (Medtronic, Minneapolis, MN, USA), ExcelsiusGPS (Globus Medical, Inc., Audubon, PA, USA), ROSA Spine (Medtech, Montpellier, France), TianJi (Beijing Tinavi Medical Technology Co., Beijing, China), and Cirq (Brainlab, Munich, Germany). [13][14][15][16] Previous studies comparing navigated robot-assisted technology with the freehand technique have demonstrated improved accuracy in screw placement and reduced radiation exposure. 9,10,17,18 However, when measuring the accuracy of robotic-guided pedicle screw placement using 3-dimensional (3D) quantitative methodology, there is still a risk of error.…”

Learning Curves for Robot-Assisted Pedicle Screw Placement: Analysis of Operative Time for 234 Cases

“…The literature is divided on the number of cases needed for mastery of robotic spine surgery, with some studies reporting steep learning curves dependent on the surgeon's prior experience and others noting minimal learning curves with rapid improvements in reliability and precision. 5,6…”