Surgeon proficiency in robot-assisted spine surgery

Abstract

Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: Bone Joint J 2020;102-B(5):568–572.

Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate

“…In recent years, there have been many studies on the robot's advantage in accuracy and selection of pedicle screws, offering benefits for both patients and surgeons [15,[19][20][21]. Preoperative CT is used to plan screw trajectories, and intraoperative fluoroscopy is applied to register images.…”

Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis

“…10 Recent studies have demonstrated that placement of PSs with robotic assistance is controversial, with limited benefits associated with significant end-user experience variability, longer operating room times, longer training times, additional training platforms, and a long learning curve compared with traditional freehand approaches. 11,12 While some systematic reviews and trials demonstrated that other methodologies have improved outcomes when compared with robotic surgery, 13,14 there are meta-analyses that have posited the superiority of robotic approaches to PS placement. 11,15 The largest meta-analysis to date concluded that CT navigation was the optimal approach for maximizing PS placement accuracy; 16 however, it only compared single-cohort studies of indirect comparisons.…”

Advances and innovations in total hip arthroplasty

“…Robotic-assisted hip arthroplasty is something that has been attempted in the past, but which must be considered afresh as new technologies have afforded an enhanced planning and user experience and will likely deliver much better results than previous iterations [ 25 ].…”

“…This fits easily into the workflow of the experienced surgeon and will help with both standard and complex cases, but will also mean that there is an ideal opportunity to collect a wealth of data generated through every step of that journey from the CT all the way through planning and then changes to the plan and then final execution leading to the ultimate outcome for the patient [ 33 ]. One day soon, we will be able to use artificial intelligence and machine learning to help deliver better plans for surgeons who perhaps do a lower volume of surgery [ 25 , 34 ].…”