Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2022 Sep 15;47(18):1279-1286. doi: 10.1097/BRS.0000000000004381. Epub 2022 Jun 29.
Retrospective cohort.
To compare robotics and navigation for minimally invasive elective lumbar fusion in terms of radiation exposure and time demand.
Although various studies have been conducted to demonstrate the benefits of both navigation and robotics over fluoroscopy in terms of radiation exposure, literature is lacking in studies comparing robotics versus navigation.
Patients who underwent elective one-level or two-level minimally invasive transforaminal lumbar interbody fusion (TLIF) by a single surgeon using navigation (Stryker SpineMask) or robotics (ExcelsiusGPS) were included (navigation 2017-2019, robotics 2019-2021, resulting in prospective cohorts of consecutive patients for each modality). All surgeries had the intraoperative computed tomography workflow. The two cohorts were compared for radiation exposure [fluoroscopy time and radiation dose: image capture, surgical procedure, and overall) and time demand (time for setup and image capture, operative time, and total operating room (OR) time].
A total of 244 patients (robotics 111, navigation 133) were included. The two cohorts were similar in terms of baseline demographics, primary/revision surgeries, and fusion levels. For one-level TLIF, total fluoroscopy time, total radiation dose, and % of radiation for surgical procedure were significantly less with robotics compared with navigation (20 vs. 25 s, P <0.001; 38 vs. 42 mGy, P =0.05; 58% vs. 65%, P =0.021). Although time for setup and image capture was significantly less with robotics (22 vs. 25 min, P <0.001) and operative time was significantly greater with robotics (103 vs. 93 min, P <0.001), there was no significant difference in the total OR time (145 vs. 141 min, P =0.25). Similar findings were seen for two-level TLIF as well.
Robotics for minimally invasive TLIF, compared with navigation, leads to a significant reduction in radiation exposure both to the surgeon and patient, with no significant difference in the total OR time.
回顾性队列研究。
比较微创腰椎融合术的机器人辅助与导航技术在辐射暴露和时间需求方面的差异。
尽管已有多项研究表明导航和机器人技术在辐射暴露方面优于透视技术，但目前缺乏机器人技术与导航技术比较的研究。
纳入由同一位医生采用导航（Stryker SpineMask）或机器人（ExcelsiusGPS）进行的选择性单节段或双节段微创经椎间孔腰椎体间融合术（TLIF）的患者（导航组：2017-2019 年；机器人组：2019-2021 年，每个阶段为连续患者的前瞻性队列）。所有手术均采用术中计算机断层扫描工作流程。比较两组患者的辐射暴露情况[透视时间和辐射剂量：图像采集、手术过程和总剂量]和时间需求[设置和图像采集时间、手术时间和总手术室（OR）时间]。
共纳入 244 例患者（机器人组 111 例，导航组 133 例）。两组患者在基线人口统计学特征、原发性/翻修手术和融合节段方面无显著差异。对于单节段 TLIF，机器人组的总透视时间、总辐射剂量和手术过程中的辐射比例明显低于导航组（20 秒 vs. 25 秒，P<0.001；38 毫戈瑞 vs. 42 毫戈瑞，P=0.05；58% vs. 65%，P=0.021）。虽然机器人组的设置和图像采集时间明显减少（22 分钟 vs. 25 分钟，P<0.001），机器人组的手术时间明显延长（103 分钟 vs. 93 分钟，P<0.001），但总 OR 时间无显著差异（145 分钟 vs. 141 分钟，P=0.25）。双节段 TLIF 也观察到类似的结果。
与导航技术相比，机器人辅助微创 TLIF 可显著降低术者和患者的辐射暴露，总 OR 时间无显著差异。
