Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
World Neurosurg. 2021 Jul;151:e10-e18. doi: 10.1016/j.wneu.2021.02.119. Epub 2021 Mar 6.
To report our experience using the scan-and-plan workflow and review current literature on surgical efficiency, safety, and accuracy of next-generation robot-assisted (RA) spine surgery.
The records of patients who underwent RA pedicle screw fixation were reviewed. The accuracy of pedicle screw placement was determined based on the Ravi classification system. To evaluate workflow efficiency, 3 demographically matched cohorts were created to analyze differences in time per screw placement (defined as operating room [OR] time divided by number of screws placed). Group A had <4 screws placed, Group B had 4 screws placed, and Group C had >4 screws placed. Intraoperative errors and postoperative complications were collected to elucidate safety.
Eighty-four RA cases (306 pedicle screws) were included for analysis. The mean number of screws placed was 2.1 ± 0.3 in Group A and 6.4 ± 1.2 in Group C; 4 screws were placed in Group B patients. The accuracy rate (Ravi grade I) was 98.4%. Screw placement time was significantly longer in Group A (101 ± 37.7 minutes) than Group B (50.5 ± 25.4 minutes) or C (43.6 ± 14.7 minutes). There were no intraoperative complications, robot failures, or in-hospital complications requiring a return to the OR.
The scan-and-plan workflow allowed for a high degree of accuracy. It was a safe method that provided a smooth and efficient OR workflow without registration errors or robotic failures. After the placement of 4 pedicle screws, the per-screw time remained constant. Further studies regarding efficiency and utility in multilevel procedures are necessary.
报告我们使用扫描规划工作流程的经验，并回顾当前关于下一代机器人辅助（RA）脊柱手术的手术效率、安全性和准确性的文献。
回顾了接受 RA 椎弓根螺钉固定的患者的记录。根据 Ravi 分类系统确定椎弓根螺钉放置的准确性。为了评估工作流程效率，创建了 3 个具有相似人口统计学特征的队列，以分析每个螺钉放置时间（定义为手术室[OR]时间除以放置的螺钉数量）的差异。A 组放置螺钉数<4，B 组放置螺钉数 4，C 组放置螺钉数>4。收集术中错误和术后并发症以阐明安全性。
共纳入 84 例 RA 病例（306 枚椎弓根螺钉）进行分析。A 组平均放置螺钉数为 2.1±0.3，C 组为 6.4±1.2；B 组放置螺钉数为 4。准确性（Ravi 分级 I）率为 98.4%。A 组（101±37.7 分钟）的螺钉放置时间明显长于 B 组（50.5±25.4 分钟）或 C 组（43.6±14.7 分钟）。无术中并发症、机器人故障或需要返回手术室的院内并发症。
扫描规划工作流程可达到高度准确性。这是一种安全的方法，提供了流畅高效的手术室工作流程，无注册错误或机器人故障。放置 4 枚椎弓根螺钉后，每枚螺钉的时间保持不变。需要进一步研究多节段手术中的效率和实用性。
