Department of Neurosurgery, Georgetown School of Medicine, Washington, DC, USA.
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD, 21218, USA.
J Robot Surg. 2024 Jul 8;18(1):282. doi: 10.1007/s11701-024-02014-5.
Eighty consecutive complex spinal robotic cases utilizing intraoperative 3D CT imaging (E3D, Group 2) were compared to 80 age-matched controls using the Excelsius robot alone with C-arm Fluoroscopic registration (Robot Only, Group 1). The demographics between the two groups were similar-severity of deformity, ASA Score for general anesthesia, patient age, gender, number of spinal levels instrumented, number of patients with prior spinal surgery, and amount of neurologic compression. The intraoperative CT scanning added several objective factors improving patient safety. There were significantly fewer complications in the E3D group with only 3 of 80 (4%) patients requiring a return to the operating room compared to 11 of 80 (14%) patients in the Robot Only Group requiring repeat surgery for implant related problems (Chi squared analysis = 5.00, p = 0.025). There was a significant reduction the amount of fluoroscopy time in the E3D Group (36 s, range 4-102 s) compared to Robot only group (51 s, range 15-160 s) (p = 0.0001). There was also shorter mean operative time in the E3D group (257 ± 59.5 min) compared to the robot only group (306 ± 73.8 min) due to much faster registration time (45 s). A longer registration time was required in the Robot only group to register each vertebral level with AP and Lateral fluoroscopy shots. The estimated blood loss was also significantly lower in Group 2 (mean 345 ± 225 ml) vs Group 1 (474 ± 397 ml) (p = 0.012). The mean hospital length of stay was also significantly shorter for Group 2 (3.77 ± 1.86 days) compared to Group 1 (5.16 ± 3.40) (p = 0.022). There was no significant difference in the number of interbody implants nor corrective osteotomies in both groups-Robot only 52 cases vs. 42 cases in E3D group.Level of evidence: IV, Retrospective review.
连续 80 例复杂脊柱机器人手术（E3D 组，第 2 组）利用术中 3D CT 成像与仅使用 ExceI I ius 机器人结合 C 臂透视注册的 80 例年龄匹配的对照（机器人仅组，第 1 组）进行了比较。两组之间的人口统计学数据相似——畸形的严重程度、全身麻醉的 ASA 评分、患者年龄、性别、手术节段数量、既往脊柱手术患者数量以及神经压迫程度。术中 CT 扫描增加了一些客观因素，提高了患者安全性。E3D 组并发症明显较少，仅 3 例（4%）患者需要返回手术室，而机器人仅组 11 例（14%）患者因植入物相关问题需要再次手术（卡方分析=5.00，p=0.025）。E3D 组的透视时间明显减少（36s，范围 4-102s），而机器人仅组（51s，范围 15-160s）（p=0.0001）。E3D 组的平均手术时间也较短（257±59.5min），而机器人仅组（306±73.8min），这是因为注册时间更快（45s）。由于需要更快的注册时间来用前后位和侧位透视图像注册每个椎体水平，机器人仅组的注册时间较长。E3D 组的估计失血量也明显低于第 1 组（平均 345±225ml 对 474±397ml）（p=0.012）。E3D 组的平均住院时间也明显短于第 1 组（3.77±1.86 天对 5.16±3.40 天）（p=0.022）。两组的椎间植入物数量和矫正性截骨术数量均无显著差异-机器人仅组 52 例，E3D 组 42 例。证据水平：IV，回顾性研究。
