Urakov Timur M, Chang Ken Hsuan-Kan, Burks S Shelby, Wang Michael Y
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Neurosurg Focus. 2017 May;42(5):E4. doi: 10.3171/2017.2.FOCUS175.
OBJECTIVE Spine surgery is complex and involves various steps. Current robotic technology is mostly aimed at assisting with pedicle screw insertion. This report evaluates the feasibility of robot-assisted pedicle instrumentation in an academic environment with the involvement of residents and fellows. METHODS The Renaissance Guidance System was used to plan and execute pedicle screw placement in open and percutaneous consecutive cases performed in the period of December 2015 to December 2016. The database was reviewed to assess the usability of the robot by neurosurgical trainees. Outcome measures included time per screw, fluoroscopy time, breached screws, and other complications. Screw placement was assessed in patients with postoperative CT studies. The speed of screw placement and fluoroscopy time were collected at the time of surgery by personnel affiliated with the robot's manufacturer. Complication and imaging data were reviewed retrospectively. RESULTS A total of 306 pedicle screws were inserted in 30 patients with robot guidance. The average time for junior residents was 4.4 min/screw and for senior residents and fellows, 4.02 min/screw (p = 0.61). Among the residents dedicated to spine surgery, the average speed was 3.84 min/screw, while nondedicated residents took 4.5 min/screw (p = 0.41). Evaluation of breached screws revealed some of the pitfalls in using the robot. CONCLUSIONS No significant difference regarding the speed of pedicle instrumentation was detected between the operators' years of experience or dedication to spine surgery, although more participants are required to investigate this completely. On the other hand, there was a trend toward improved efficiency with more cases performed. To the authors' knowledge, this is the first reported academic experience with robot-assisted spine instrumentation.
目的 脊柱手术复杂，涉及多个步骤。当前的机器人技术主要旨在辅助椎弓根螺钉植入。本报告评估在有住院医师和研究员参与的学术环境中机器人辅助椎弓根器械植入的可行性。方法 使用Renaissance导航系统对2015年12月至2016年12月期间连续进行的开放和经皮病例进行椎弓根螺钉置入的规划和操作。回顾数据库以评估神经外科实习生对机器人的使用情况。结果指标包括每颗螺钉的操作时间、透视时间、螺钉穿破情况及其他并发症。通过术后CT研究评估患者的螺钉置入情况。手术时由机器人制造商的工作人员收集螺钉置入速度和透视时间。对并发症和影像数据进行回顾性分析。结果 在机器人引导下，共为30例患者植入306枚椎弓根螺钉。初级住院医师平均每颗螺钉操作时间为4.4分钟，高级住院医师和研究员为4.02分钟（p = 0.61）。在专门从事脊柱手术的住院医师中，平均速度为每颗螺钉3.84分钟，而非专门从事脊柱手术的住院医师为4.5分钟（p = 0.41）。对穿破螺钉的评估揭示了使用机器人时的一些陷阱。结论 尽管需要更多参与者进行全面研究，但在手术者的经验年限或对脊柱手术的专注程度方面，未发现椎弓根器械植入速度有显著差异。另一方面，随着手术病例增多，有效率提高的趋势。据作者所知，这是首次报道的机器人辅助脊柱器械植入的学术经验。
