A prospective, randomized, controlled trial of robot‐assisted vs freehand pedicle screw fixation in spine surgery

Kim, Ho-Joong; Jung, Whan Ik; Chang, Bong Soon; Lee, Choon-Ki; Kang, Kyoung‐Tak; Yeom, Jin Sup

doi:10.1002/rcs.1779

Cited by 193 publications

(256 citation statements)

References 22 publications

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“…2,5,6,9,[11][12][13][14][15]17,21,22,24,25,[27][28][29][30][31][35][36][37] Twenty-one of these studies used variations of the robot developed by Mazor, whereas 1 study evaluated the ROSA robot. Twenty-one studies evaluated pedicle screw accuracy, whereas Dreval et al evaluated both pedicle screws and guided oblique lumbar interbody fusion (GO-LIF) screws, 6 and Bederman et al evaluated the accuracy of S2-alar-iliac screw placement.…”

Section: Accuracy Of Spinal Instrumentationmentioning

confidence: 99%

“…31 Onen et al described an FT of 1.3 seconds per screw, whereas Kim et al described a total FT of 20.4 seconds. 15,24 Roser et al evaluated both standard navigation and freehand techniques in comparison with robotically placed screws. 28 They reported that FT and radiation dosage were lowest in the standard navigation group, followed by the robotic group.…”

Section: Radiation Exposurementioning

confidence: 99%

“…5,10,12,15,22,24,27,29 Devito et al found that the ability to place screws robotically was 83.7% in their total cohort, but increased to a 90.8% execution rate when they looked at their most recent procedures. 5 In addition, time per screw placement decreased from 13.5 minutes for single-level cases (4 minutes per screw in multilevel cases) to 10.6 minutes (2 minutes in multilevel cases).…”

Section: Learning Curvementioning

confidence: 99%

“…12 Kim et al found a decrease in total FT from 27.5 seconds to 18.5 seconds. 15 Schatlo et al graded the accuracy of screw placement in 13 surgeons. 29 For each surgeon, accuracy was graded in 5-case increments.…”

Section: Learning Curvementioning

confidence: 99%

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Current applications of robotics in spine surgery: a systematic review of the literature

Joseph

Smith

2017

Neurosurgical Focus

171

144

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OBJECTIVESurgical robotics has demonstrated utility across the spectrum of surgery. Robotics in spine surgery, however, remains in its infancy. Here, the authors systematically review the evidence behind robotic applications in spinal instrumentation.METHODSThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies (through October 2016) that reported the use of robotics in spinal instrumentation were identified from a search of the PubMed database. Data regarding the accuracy of screw placement, surgeon learning curve, radiation exposure, and reasons for robotic failure were extracted.RESULTSTwenty-five studies describing 2 unique robots met inclusion criteria. Of these, 22 studies evaluated accuracy of spinal instrumentation. Although grading of pedicle screw accuracy was variable, the most commonly used method was the Gertzbein and Robbins system of classification. In the studies using the Gertzbein and Robbins system, accuracy (Grades A and B) ranged from 85% to 100%. Ten studies evaluated radiation exposure during the procedure. In studies that detailed fluoroscopy usage, overall fluoroscopy times ranged from 1.3 to 34 seconds per screw. Nine studies examined the learning curve for the surgeon, and 12 studies described causes of robotic failure, which included registration failure, soft-tissue hindrance, and lateral skiving of the drill guide.CONCLUSIONSRobotics in spine surgery is an emerging technology that holds promise for future applications. Surgical accuracy in instrumentation implanted using robotics appears to be high. However, the impact of robotics on radiation exposure is not clear and seems to be dependent on technique and robot type.

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Section: Accuracy Of Spinal Instrumentationmentioning

confidence: 99%

Section: Radiation Exposurementioning

confidence: 99%

Section: Learning Curvementioning

confidence: 99%

Section: Learning Curvementioning

confidence: 99%

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Current applications of robotics in spine surgery: a systematic review of the literature

Joseph

Smith

2017

Neurosurgical Focus

171

144

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“…2). 20,24 Cranial applications for these robots include stereotactic deep brain stimulator placement, laser thermal ablation therapy, tumors, and endoscope navigations. 6,8,18,56 In cranial surgeries, the preoperative MRI is merged with the intraoperative CT or MRI scan.…”

Section: 45mentioning

confidence: 99%

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Madhavan¹,

Kolcun²,

Chieng³

et al. 2017

Neurosurgical Focus

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Surgical robots have captured the interest—if not the widespread acceptance—of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. “Faster, better, cheaper” products should in theory conquer the market, but often fail. The psychology of change is complex, and the “follow the leader” mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons’ dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots (“cobots”), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a “follow the leader” phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon’s hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

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Research quality and transparency, outcome measurement and evidence for safety and effectiveness in robot-assisted surgery: systematic review

et al. 2020

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Background: Robot-assisted surgery (RAS) has potential panspecialty surgical benefits. High-quality evidence for widespread implementation is lacking. This systematic review aimed to assess the RAS evidence base for the quality of randomized evidence on safety and effectiveness, specialty 'clustering', and outcomes for RAS research. Methods: A systematic review was undertaken according to PRISMA guidelines. All pathologies and procedures utilizing RAS were included. Studies were limited to RCTs, the English language and publication within the last decade. The main outcomes selected for the review design were safety and efficacy, and study purpose. Secondary outcomes were study characteristics, funding and governance. Results: Searches identified 7142 titles, from which 183 RCTs were identified for data extraction. The commonest specialty was urology (35⋅0 per cent). There were just 76 unique study populations, indicating significant overlap of publications; 103 principal studies were assessed further. Only 64⋅1 per cent of studies reported a primary outcome measure, with 29⋅1 per cent matching their registration/protocol. Safety was assessed in 68⋅9 per cent of trials; operative complications were the commonest measure. Forty-eight per cent of trials reported no significant difference in safety between RAS and comparator, and 11 per cent reported RAS to be superior. Efficacy or effectiveness was assessed in 80⋅6 per cent of trials; 43 per cent of trials showed no difference between RAS and comparator, and 24 per cent reported that RAS was superior. Funding was declared in 47⋅6 per cent of trials. Conclusion: The evidence base for RAS is of limited quality and variable transparency in reporting. No patterns of harm to patients were identified. RAS has potential to be beneficial, but requires continued high-quality evaluation.

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A prospective, randomized, controlled trial of robot‐assisted vs freehand pedicle screw fixation in spine surgery

Abstract: Robotic-assisted pedicle screw placement was associated with fewer proximal facet joint violations and better convergence orientations.

Cited by 193 publications

References 22 publications

Current applications of robotics in spine surgery: a systematic review of the literature

Current applications of robotics in spine surgery: a systematic review of the literature

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Research quality and transparency, outcome measurement and evidence for safety and effectiveness in robot-assisted surgery: systematic review

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