Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

Background Robot-assisted open surgery (RA-OS) is now commonly used in traditional open-exposure spinal screw placement surgery. With the help of robots, robot-assisted minimally invasive surgery (RA-MIS) can achieve less bleeding and less tissue damage in percutaneous screw insertion. While the research comparing the safety and accuracy of screw placement between RA-MIS and RA-OS is insufficient. This study aims to compare the effects of RA-MIS and RA-OS in thoracic and lumbar spine. Methods This was a prospective cohort study evaluating 208 patients undergoing robot-assisted screw insertions from July 2020 to September 2021. Age, BMI, gender, screws accuracy, screws Gertzbein–Robbins grade, small joint invasion and perioperative outcomes (operation time, blood loss, postoperative hospital stay, comorbidity) were collected. A subgroup analysis was also performed according to disease, namely fracture, spondylolisthesis, and disc herniation. Data were analyzed using Stata/MP 14.0. Wilcoxon’s signed rank test, Kruskal–Wallis test and Fisher’s exact test were used for statistical tests and p < 0.05 was considered statistically significant. Results A total of 1030 screws were inserted; 368 minimally invasive screws and 662 open screws. The acceptability of screw insertion in the RA-MIS and RA-OS was 97.3% and 95.6% respectively. There was no statistical difference between the RA-MIS group and RA-OS group in age (p = 0.106), gender (p = 0.074), BMI (p = 0.181) and comorbidity (p = 0.203). Compared with RA-OS, RA-MIS had less blood loss (p < 0.001) and shorter postoperative hospital stay (p = 0.008). In the minimally invasive surgery group, the fracture subgroup had smaller screw deviation, less blood loss, and shorter operation time compared with the other subgroups (p < 0.01). Specifically, RA-MIS significantly reduced the postoperative hospital stay of patients with spondylolisthesis compared with RA-OS (p < 0.01). Conclusion RA-OS and RA-MIS had equal accuracy and safety. Compared with open surgery, minimally invasive surgery reduced blood loss in each subgroup and shortened the postoperative hospital stay in the spondylolisthesis subgroup. Compared with the other subgroups under minimally invasive surgery, the fracture subgroup had less blood loss and shorter operation time. Clinical trial registration: NCT04040868. Registered 1 March 2019, https://clinicaltrials.gov/ct2/show/NCT04040868?cond=Accuracy+Study+of+Robot-assisted+Screw+Insertion+in+Spinal+Surgery&draw=2&rank=1.

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Maturation arrest is a common cause of male infertility which has caused worldwide concern, and its pathophysiological process remains further elucidation. Our study aimed to identify genetic characteristics of maturation arrest by comparing gene expression between maturation arrest and normal samples using microarray technology. A total of 6,373 genes were identified differentially expressed (p < .05, fold change > 2.0 or <−2.0) and 1,594 genes were selected as statistically significant after Bonferroni correction, including 419 up‐regulated and 1,175 down‐regulated genes. Microarray data were validated by quantitative reverse transcriptase–polymerase chain reaction. Bioinformation analysis was performed to explore genetic function of statistically significant genes. Gene Ontology results showed the statistically significant genes enriched in sexual reproduction, spermatogenesis and male gamete generation. Reactome pathway analysis highlighted the olfactory signalling pathway, fertilisation, developmental biology, etc. One module and eight hub genes were found to be involved in ubiquitin‐mediated proteolysis and may affect as indicators of spermatogenic process through protein–protein interaction analysis. Our study provided a comprehensive genetic characteristic of differential expressed genes in testicular tissues from maturation arrest patients and speculated several genes as potential indicators of disease.