The use of robotics in minimally invasive spine surgery

Abstract

The field of spine surgery has changed significantly over the past few decades as once technological fantasy has become reality. The advent of stereotaxis, intra-operative navigation, endoscopy, and percutaneous instrumentation have altered the landscape of spine surgery. The concept of minimally invasive spine (MIS) surgery has blossomed over the past ten years and now robot-assisted spine surgery is being championed by some as another potential paradigm altering technological advancement. The application of robotics in other surgical specialties has been shown to be a safe and feasible alternative to the traditional, open approach. In 2004 the Mazor Spine Assist robot was approved by FDA to assist with placement of pedicle screws and since then, more advanced robots with promising clinical outcomes have been introduced. Currently, robotic platforms are limited to pedicle screw placement. However, there are centers investigating the role of robotics in decompression, dural closure, and pre-planned osteotomies.Robot-assisted spine surgery has been shown to increase the accuracy of pedicle screw placement and decrease radiation exposure to surgeons. However, modern robotic technology also has certain disadvantages including a high introductory cost, steep learning curve, and inherent technological glitches. Currently, robotic spine surgery is in its infancy and most of the objective evidence available regarding its benefits draws from the use of robots in a shared-control model to assist with the placement of pedicle screws. As artificial intelligence software and feedback sensor design become more sophisticated, robots could facilitate other, more complex surgical tasks such as bony decompression or dural closure. The accuracy and precision afforded by the current robots available for use in spinal surgery potentially allow for even less tissue destructive and more meticulous MIS surgery. This article aims to provide a contemporary review of the use of robotics in MIS surgery.

Surgeons' Learning Curve of Renaissance Robotic Surgical System

“…In total, 281 screws were placed in the pedicles and a mean of 4.5 6 3.2 levels (range, 1 to 6) were fused; however, in the literature and according to Medtronic the number of levels depends upon the intraoperative radiography. 23 The average time was 8.6 minutes (63.3 minutes) per screw placement, with a negative trend in surgery time (slope ¼À0.05). Similar results were found for the robotic time, in addition to surgery and anesthesia times, which demonstrated the highest trend with a slope of À3.64 and À3.97, respectively.…”

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

“…The robotic spine surgery, as an innovation, has introduced many technologies, such as optical navigation and planning programs. 41 The intelligent algorithms can automatically and accurately navigate the screw placement, and their high accuracy can avoid repeated fluoroscopy. 40 Besides, most previous clinical trials focused on lumbar vertebral, and the skills and experience of surgeons in operating at the lumbar level also contributed to a better performance of the robots, which lowered the radiation dose.…”

The Future of Skull Base Surgery: A View Through Tinted Glasses

“…The Mazor X Stealth spine robot (Medtronic Co., Minneapolis, Minnesota, USA) has proved to be very useful for the precise placement of pedicle screws in transforaminal lumbar interbody fusion surgery and minimally invasive spine surgery. 50 For cranial surgery, the NeuroArm developed by Garnette Sutherland, University of Calgary (Calgary, Alberta, Figure 4. The Raven II table-mounted robot for abdominal surgery in use experimentally (not approved for use in humans).…”