Vaccaro Alexander R, Harris Jonathan A, Hussain Mir M, Wadhwa Rishi, Chang Victor W, Schroerlucke Samuel R, Samora Walter P, Passias Peter G, Patel Rakesh D, Panchal Ripul R, D'Agostino Sabino, Whitney Nathaniel L, Crawford Neil R, Bucklen Brandon S
Rothman Institute, 6559Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Musculoskeletal Education and Research Center, A Division of 110044Globus Medical, Inc, Audubon, PA, USA.
Global Spine J. 2020 Oct;10(7):814-825. doi: 10.1177/2192568219879083. Epub 2019 Sep 24.
Cadaveric study.
To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures.
Ten board-certified surgeons inserted 16 pedicle screws at T10-L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2-L5, patient left pedicles), (2) MIS RAN (L2-L5, patient right pedicles), (3) conventional open technique (T10-L1, patient left pedicles), and (4) open RAN (T10-L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy.
In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, = .650).
RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.
尸体研究。
评估一种新型机器人辅助导航（RAN）平台与传统开放手术和经皮手术中的徒手技术相比的准确性、辐射暴露量和手术时间。
10名具备专业资格认证的外科医生在10具人体尸体躯干上于T10 - L5节段置入16枚椎弓根螺钉（每种技术40枚）。椎弓根螺钉的置入采用以下方法：（1）传统微创技术（L2 - L5，患者左侧椎弓根），（2）微创RAN技术（L2 - L5，患者右侧椎弓根），（3）传统开放技术（T10 - L1，患者左侧椎弓根），以及（4）开放RAN技术（T10 - L1，患者右侧椎弓根）。观察指标包括：（1）手术时间，（2）透视图像数量，以及（3）螺钉置入准确性。
在微创组中，与徒手技术相比，RAN技术允许使用更大直径的螺钉（直径：6.6±0.6毫米对6.3±0.5毫米；长度：50.3±4.1毫米对46.9±3.5毫米），减少了大于2毫米的穿破数量（0对7），透视图像数量更少（0±0对108.3±30.9），以及每枚螺钉的手术操作时间更短（3.6±0.4分钟对7.6±2.0分钟）（所有P值均＜0.05）。同样，在开放组中，RAN技术允许使用更长的螺钉（46.1±4.1毫米对 44.0±3.8毫米），减少了大于2毫米的穿破数量（0对13），透视图像数量更少（0±0对24.1±25.8）（所有P值均＜0.05），但总手术操作时间增加（41.4±8.8分钟对24.7±7.0分钟，P = 0.000），而螺钉置入时间保持不变（3.3±1.4分钟对3.1±1.0分钟，P = 0.650）。
与尸体的传统开放手术和经皮手术中的徒手技术相比，RAN技术显著提高了准确性并减少了辐射暴露。与两种传统手术相比，RAN技术显著增加了准备时间。
