Robotic navigation in spine surgery: Where are we now and where are we going?

Wang, Timothy Y.; Park, Christine; Dalton, Tara; Rajkumar, Shashank; McCray, Edwin; Owolo, Edwin; Than, Khoi D.; Abd-El-Barr, Muhammad M.

doi:10.1016/j.jocn.2021.10.034

Cited by 15 publications

(14 citation statements)

References 65 publications

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“…Hence, the cost-effectiveness of the utilization of robotics in spine surgery is still unclear. 44 Although more future work on this topic is required, the current study definitely helps to justify the high cost of the robotic platform by demonstrating a significant reduction in radiation exposure compared with navigation. Addressing a major concern around This study has a few limitations.…”

Section: Discussionmentioning

confidence: 85%

“…Although robotic assistance has been associated with increased pedicle screw accuracy and size compared with navigation, data regarding hospital costs and long-term clinical outcomes is still scarce. Hence, the cost-effectiveness of the utilization of robotics in spine surgery is still unclear 44. Although more future work on this topic is required, the current study definitely helps to justify the high cost of the robotic platform by demonstrating a significant reduction in radiation exposure compared with navigation.…”

Section: Discussionmentioning

confidence: 88%

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Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Shahi

Vaishnav

Araghi

et al. 2022

Spine

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Study Design. Retrospective cohort. Objective. To compare robotics and navigation for minimally invasive elective lumbar fusion in terms of radiation exposure and time demand. Summary of Background Data. Although various studies have been conducted to demonstrate the benefits of both navigation and robotics over fluoroscopy in terms of radiation exposure, literature is lacking in studies comparing robotics versus navigation. Materials and Methods. Patients who underwent elective one-level or two-level minimally invasive transforaminal lumbar interbody fusion (TLIF) by a single surgeon using navigation (Stryker SpineMask) or robotics (ExcelsiusGPS) were included (navigation 2017–2019, robotics 2019–2021, resulting in prospective cohorts of consecutive patients for each modality). All surgeries had the intraoperative computed tomography workflow. The two cohorts were compared for radiation exposure [fluoroscopy time and radiation dose: image capture, surgical procedure, and overall) and time demand (time for setup and image capture, operative time, and total operating room (OR) time]. Results. A total of 244 patients (robotics 111, navigation 133) were included. The two cohorts were similar in terms of baseline demographics, primary/revision surgeries, and fusion levels. For one-level TLIF, total fluoroscopy time, total radiation dose, and % of radiation for surgical procedure were significantly less with robotics compared with navigation (20 vs. 25 s, P<0.001; 38 vs. 42 mGy, P=0.05; 58% vs. 65%, P=0.021). Although time for setup and image capture was significantly less with robotics (22 vs. 25 min, P<0.001) and operative time was significantly greater with robotics (103 vs. 93 min, P<0.001), there was no significant difference in the total OR time (145 vs. 141 min, P=0.25). Similar findings were seen for two-level TLIF as well. Conclusion. Robotics for minimally invasive TLIF, compared with navigation, leads to a significant reduction in radiation exposure both to the surgeon and patient, with no significant difference in the total OR time.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 88%

Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Shahi

Vaishnav

Araghi

et al. 2022

Spine

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“…Results of cost analyses remain mixed, yet robotic platform cost-effectiveness is a primary desire of surgeons. 76,77…”

Section: Available Evidencementioning

confidence: 99%

“…Results of cost analyses remain mixed, yet robotic platform cost-effectiveness is a primary desire of surgeons. 76,77 A key study reviewed 577 thoracolumbar elective clinical cases retrospectively to estimate the potential cost-effectiveness if robotic technology had been implemented. 78 They estimated a total savings of $608,546 over a 1-year period, based on estimated cost savings from conducting additional minimally invasive surgeries, avoiding surgical revisions, achieving lower infection rates, and decreasing length of hospital stays.…”

Section: Learning Curve and Costsmentioning

confidence: 99%

Robotic Spine Surgery: Past, Present and Future.

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

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“…For example, the Da Vinci robot has been widely used in general surgery [ 5 ], urology [ 6 ], gynecology [ 7 ], and other fields. Robot-assisted spinal surgery has also been applied in clinical practice [ 8 ]. It has been confirmed to be superior to manual operations in terms of safety, accuracy, the amount of radiation to surgeons, and the learning curve [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation

Chang

et al. 2022

JCM

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Robot-assisted orthopedic surgery has great application prospects, and the accuracy of the robot is the key to its overall performance. The aim of this study was to develop a new orthopedic surgical robot to assist in spinal surgeries and to compare its feasibility and accuracy with the existing orthopedic robot. A new type of high-precision orthopedic surgical robot (Tuoshou) was developed. A multicenter, randomized controlled trial was carried out to compare the Tuoshuo with the TiRobot (TINAVI Medical Technologies Co., Ltd., Beijing) to evaluate the accuracy and safety of their navigation and positioning. A total of 112 patients were randomized, and 108 patients completed the study. The position deviation of the Kirschner wire placement in the Tuoshuo group was smaller than that in the TiRobot group (p = 0.014). The Tuoshuo group was better than the TiRobot group in terms of the pedicle screw insertion accuracy (p = 0.016) and entry point deviation (p < 0.001). No differences were observed in endpoint deviation (p = 0.170), axial deviation (p = 0.170), sagittal deviation (p = 0.324), and spatial deviation (p = 0.299). There was no difference in security indicators. The new orthopedic surgical robot was highly accurate and optimized for clinical practice, making it suitable for clinical application.

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Robotic navigation in spine surgery: Where are we now and where are we going?

Cited by 15 publications

References 65 publications

Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Robotic Spine Surgery: Past, Present and Future.

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation

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