Robot-assisted percutaneous placement of K-wires during minimally invasive interventions of the spine

Croissant, Yann; Zangos, Stephan; Albrecht, Moritz H.; Eichler, Katrin; Schomerus, Christof; Spandorfer, Adam; Schoepf, U. Joseph; Vogl, Thomas J.; Czerny, C.

doi:10.1080/13645706.2018.1544567

Cited by 16 publications

(17 citation statements)

References 26 publications

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“…We find a very high accuracy as shown in bone entry deviation data and angular errors (0.48 ± 0.44 mm, 0.94 ± 0.83° and 0.68 ± 0.58 mm, 0.87 ± 0.82°) in the axial and sagittal planes, respectively. This is in line with top performers among previously published material on bone entry deviation accuracy and superior in regard to angular errors (Table 3) [30][31][32][33][34][35][36] . This in turn resulted in a favorable simulated Gertzbein grading (100% accuracy), well in line with the vast majority of recent studies that typically report 98 -100% accuracy 34,[37][38][39][40][41] .…”

Section: Discussionsupporting

confidence: 89%

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Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Burström

Balicki

Patriciu

et al. 2020

Sci Rep

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Adrian elmi-terander 1,2 the combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. the robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable. The insertion of pedicle screws remains one of the critical steps in spine surgeries involving thoracolumbar posterior fixation. The procedure poses risks for complications, as both neural and vascular structures are in close proximity to the pedicles. A meta-analysis by Gelalis et al. reported that 1-6.5% of pedicle screws placed using free-hand technique had a cortical violation >4 mm 1. Meanwhile, minimally invasive spine (MIS) surgery is increasingly preferred due to reductions in blood loss, length of hospital stay, and surgical site infections 2. Accuracy and complication rates, however, are not different 3,4. When relying only on fluoroscopy in MIS, the pedicle perforation rate has been reported to be in the range of 12.5-13.5% 5-7. Since MIS reduces anatomical feedback to the surgeon, it can be argued that image guidance, and perhaps also robotic guidance, has a natural role in this kind of surgery 8. The promises of increased accuracy, decreased complication rates, and reduced radiation exposure to the surgical team has led to an increasing use of robots in MIS surgery 9. There are currently several navigated robotic systems available on the market employing various strategies for 3D planning using pre-or intraoperative fluoroscopy or CT. The most frequently reported ones in the literature are the Mazor robots (MAZOR Robotics Ltd., Caesarea, Israel) and the ROSA Spine system (Medtech S.A., Montpellier, France). The Mazor robot...

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Section: Discussionsupporting

confidence: 89%

“…Furthermore, our insertion times are also relatively short compared to other robotic systems. In studies reporting on comparable parts of the surgery, mean time per pedicle cannulation was 202-257 seconds 31,35 . These times do not entirely represent the time per pedicle screw, as no screw was inserted.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Burström

Balicki

Patriciu

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Therefore, significant superiority of robotic surgery in accuracy of screw placement compared with FH has been extensively demonstrated. 83 Despite many studies show the evidence of advantages of ro-botic surgery in timing, rates of infections and complications, there are evidences of the contrary. Indeed, some limitations of robotic spine surgery have been described.…”

Section: Discussionmentioning

confidence: 99%

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

et al. 2020

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Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.

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“…Robots have been extensively employed in many surgical fields [10][11][12]. Robots have been used to assist in all aspects of spinal surgery, including improving the accuracy of spinal internal fixation, reducing exposure to radiation and improving operating room workflow [13][14][15]. The use of robots in assisted surgery enables surgeons to make significant improvements in coordination, three-dimensional visualization and fatigue reduction.…”

Section: Introductionmentioning

confidence: 99%

Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

et al. 2020

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Background: The traditional navigation interface was intended only for two-dimensional observation by doctors; thus, this interface does not display the total spatial information for the lesion area. Surgical navigation systems have become essential tools that enable for doctors to accurately and safely perform complex operations. The image navigation interface is separated from the operating area, and the doctor needs to switch the field of vision between the screen and the patient's lesion area. In this paper, augmented reality (AR) technology was applied to spinal surgery to provide more intuitive information to surgeons. The accuracy of virtual and real registration was improved via research on AR technology. During the operation, the doctor could observe the AR image and the true shape of the internal spine through the skin. Methods: To improve the accuracy of virtual and real registration, a virtual and real registration technique based on an improved identification method and robotassisted method was proposed. The experimental method was optimized by using the improved identification method. X-ray images were used to verify the effectiveness of the puncture performed by the robot. Results: The final experimental results show that the average accuracy of the virtual and real registration based on the general identification method was 9.73 ± 0.46 mm (range 8.90-10.23 mm). The average accuracy of the virtual and real registration based on the improved identification method was 3.54 ± 0.13 mm (range 3.36-3.73 mm). Compared with the virtual and real registration based on the general identification method, the accuracy was improved by approximately 65%. The highest accuracy of the virtual and real registration based on the robot-assisted method was 2.39 mm. The accuracy was improved by approximately 28.5% based on the improved identification method. Conclusion: The experimental results show that the two optimized methods are highly very effective. The proposed AR navigation system has high accuracy and stability. This system may have value in future spinal surgeries.

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Robot-assisted percutaneous placement of K-wires during minimally invasive interventions of the spine

Cited by 16 publications

References 26 publications

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

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