ما هي مميزات الجراحة الروبوتية؟
تنبيه من الخبراء: 4 فوائد لجراحة العمود الفقري الروبوتية - أخبار مايو ...
مدينة روتشستر، ولاية مينيسوتا- تسمح الجراحة الروبوتية، أو الجراحة بمساعدة الروبوت، للأطباء بإجراء العديد من الإجراءات المعقدة - منها ما يشمل ...
Jun 25, 2021
لدراسة
ومن بين الـ 402 مسمارًا التي وُضعت في 77 مريضًا خضعوا لجراحة العمود الفقري بمساعدة الروبوت، بين أيلول/سبتمبر 2018 وتشرين الأول/أكتوبر 2019، لم يتطلب أي منها مراجعة بعد العملية، وفقًا <anchor>لدراسة</anchor> حديثة نُشرت في مجلة مايو كلينك بروسيدنجز. حيث تطلب اثنان من الـ 402 مسمارًا تعديلات أثناء العملية، ولم تظهر لدى أي من المرضى في الدراسة أي مضاعفات متعلقة بعملية وضع المسامير.
Initiation of a Robotic Program in Spinal Surgery: Experience at a Three-Site Medical Center - ScienceDirect
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## Mayo Clinic Proceedings

# Original article  Initiation of a Robotic Program in Spinal Surgery: Experience at a Three-Site Medical Center

Author links open overlay panelMohamadBydonMDab, Selby G.ChenMDc, Matthew D.NealMDd, ChandanKrishnaMDd, Aaron J.BiedermannMA, MBAa, Travis C.PaulMBAa, Yagiz U.YolcuMDab, AnshitGoyalMBBS, MSab, Bernard R.BendokMDd, AlfredoQuinones-HinojosaMDc, Robert J.SpinnerMDa, Fredric B.MeyerMDa

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## Abstract

### Objective

To highlight the early experience of implementing a robotic spine surgery program at a three-site medical center, evaluating the impact of increasing experience on the operative time and number of procedures performed.

### Patients and Methods

A retrospective chart review of patients undergoing robotic screw placement between September 4, 2018, and October 16, 2019, was conducted. Baseline characteristics as well as intraoperative and post-operative outcomes were obtained.

### Results

For a total of 77 patients, the mean age (SD) was 55.7 years (11.5) and 49.4% (n=38) were female. A total of 402 screws were placed (384 pedicle screws, 18 cortical screws) using robotic guidance with a median of two operative levels (interquartile range [IQR], 1 to 2). Median (IQR) estimated blood loss was 100 mL (50 to 200 mL) and the median (IQR) operative time was 224 minutes (193 to 307 minutes). With accrual of surgical experience, operative time declined significantly (R=-0.39; P <.001) whereas the number of procedures performed per week increased (R=0.30; P =.05) throughout the study period. Median (IQR) length of hospital stay following surgery was 2 days (IQR, 2 to 3 days). There were two screws requiring revision intraoperatively. No postoperative revisions were required, and no complications were encountered related to screw placement.

### Conclusion

Early experience at our institution using a spinal robot has demonstrated no requirement for postoperative screw revisions and no complications related to screw malposition. The increased operative times were reduced as the frequency of procedures increased. Moreover, procedural times diminished over a short period with a weekly increasing number of procedures.

## Section snippets

## Cohort Selection and Outcomes of Interest

Following Institutional Review Board approval, records of all patients undergoing pedicle or cortical screw placement using robotic-guidance at three Mayo Clinic sites in Rochester, Minnesota, Jacksonville, Florida, and Phoenix, Arizona, between September 4, 2018, and October 16, 2019, were obtained. Only patients presenting with degenerative spine disease (disc herniation and spondylolisthesis) were included whereas cases of spinal tumor, trauma, or infection were excluded. The following

## Results

A total of 77 patients underwent spinal surgery using robotic-guided screw placement by seven surgeons from the Departments of Neurologic Surgery and Orthopedic Surgery. Mean age (SD) was 55.7 (11.5) years and 49.4% (n=38) were females. Approximately 18.2% (n=14) of procedures were revision surgeries. Median (IQR) number of operative levels was 2 (1-2) levels. A total of 402 screws were placed, with 4.5% (n=18) along a cortical trajectory and the remaining (n=384; 95.5%) being pedicle screws.

## Discussion

A preliminary analysis of our initial experience with robot-guided screw placement in spine surgery showed promising results. Intraoperative revision was required for only two screws (0.5%) of 402 screws placed. Moreover, no postoperative revisions were needed for screw placement and no complications related to screw misplacement were encountered. A decrease in mean operative time was noted with each additional month of experience.

One of the early examples of robot-guided spine surgery came

## Conclusion

Initial experience from implementation of a robotic spine surgery program at a three-site enterprise medical center shows potential to achieve better intraoperative as well as postoperative outcomes. Surgeons should be cognizant of the potential learning curve with adoption of this new technology. Future studies should also evaluate the impact of robotic surgery on cost-effectiveness of spine surgery.

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View more references

## Cited by (6)

2024, World Neurosurgery

Show abstract

Neurosurgical technologies have become increasingly more adaptive, featuring real-time and patient-specific guidance in preoperative, intraoperative, and postoperative settings. This review offers insight into how these integrative innovations compare with conventional approaches in spine surgery, focusing on machine learning (ML), artificial intelligence, augmented reality and virtual reality, and spinal navigation systems. Data on technology applications, diagnostic and procedural accuracy, intraoperative times, radiation exposures, postoperative outcomes, and costs were extracted and compared with conventional methods to assess their advantages and limitations. Preoperatively, augmented reality and virtual reality have applications in surgical training and planning that are more immersive, case specific, and risk-free and have been shown to enhance accuracy and reduce complications. ML algorithms have demonstrated high accuracy in predicting surgical candidacy (up to 92.1%) and tailoring personalized treatments based on patient-specific variables. Intraoperatively, advantages include more accurate pedicle screw insertion (96%–99% with ML), enhanced visualization, reduced radiation exposure (49 μSv with O-arm navigation vs. 556 μSv with fluoroscopy), increased efficiency, and potential for fewer intraoperative complications compared with conventional approaches. Postoperatively, certain ML and artificial intelligence models have outperformed conventional methods in predicting all postoperative complications of >6000 patients as well as predicting variables contributing to in-hospital and 90-day mortality. However, applying these technologies comes with limitations, such as longer operative times (up to 35.6% longer) with navigation, dependency on datasets, costs, accessibility, steep learning curve, and inherent software malfunctions. As these technologies advance, continuing to assess their efficacy and limitations will be crucial to their successful integration within spine surgery.

2024, Journal of Korean Neurosurgical Society

2023, Neurosurgical Review

2022, Journal of Bone and Joint Surgery

2022, Neurosurgical Focus

2021, Journal of Clinical Medicine

Potential Competing Interests: The authors report no potential competing interests.

© 2020 Mayo Foundation for Medical Education and Research

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