Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: A systemic review

Abstract

Whenever any new technology is introduced into the healthcare system, it should satisfy all three pillars of the iron triangle of health care, which are quality, cost-effectiveness, and accessibility. There has been quite advancement in the field of spine surgery in the last two decades with introduction of new technological modalities such as CAN and surgical robotic devices. MAZOR SpineAssist/Renaissance was the first robotic system to be approved for the use in spine surgeries in the USA in 2004. In this review, the authors sought to determine if the current literature supports this technology to be cost-effective, accessible, and improve the quality of care for individuals and populations by increasing the likelihood of desired health outcomes. Robotic-assisted surgery seems to provide perfection in surgical ergonomics and surgical dexterity, consequently improving patient outcomes. A lot of data is present on the accuracy, effectiveness, and safety of the robotic-guided technology which reflects remarkable improvements in quality of care, making its utility convincingly undisputable. The technology has been claimed to be cost-effective but there seems to be lack of data in the literature on this topic to validate this claim. Apart from just the outcome parameters, there is an immense need of studies on real-time cost-efficacy, patient perspective, surgeon and resident learning curve, and their experience with this new technology. Furthermore, new studies looking into increased utilities of this technology, such as brain and spine tumor resection, deep brain stimulation procedures, and osteotomies in deformity surgery, might authenticate the cost of the equipment.

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

“…Furthermore, we are unable to conduct a detailed evaluation of cost-effectiveness. The cost–value relationship of robotic and intraoperative imaging systems remains controversial, and it is as of yet unclear if there are any demonstrable clinical benefits that warrant the high acquisition and maintenance costs inherent to these systems 22. In addition, preoperative radiation that may be required for surgical planning may differ among the groups, and is not captured.…”

“…While there is some evidence that RG and NV lead to higher radiological accuracy than FH instrumentation,12 16–21 this may not translate directly to real-world clinical benefits, especially in light of the high acquisition and maintenance costs inherent to these systems 22. A recent systematic review on the cost-effectiveness of RG concluded that, although the technology is often claimed to be cost-effective, there appears to be a lack of published data to warrant this statement 22.…”

“…While there is some evidence that RG and NV lead to higher radiological accuracy than FH instrumentation,12 16–21 this may not translate directly to real-world clinical benefits, especially in light of the high acquisition and maintenance costs inherent to these systems 22. A recent systematic review on the cost-effectiveness of RG concluded that, although the technology is often claimed to be cost-effective, there appears to be a lack of published data to warrant this statement 22. Possible benefits could include shorter operating times, and decreased incidences of radiculopathy and costly revision surgery for screw malposition, although the current level of evidence is very low, and there are no large prospective controlled studies comparing clinically relevant outcome such as pedicle screw-related revision surgery, as opposed to radiological surrogate measures alone 5 6 14 21–30…”

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

“…However, revision surgeries are not only technically challenging to the surgeons but also physically and emotionally stressful for the patients. 50 As a major benefit of RA MIS, accurate pedicle screw placement should theoretically reduce the incidence of revision rates.…”

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

“…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.…”