Benech Carlo A, Perez Rosa, Lucyk Isabella, Bucklen Brandon S
Department of Neurology and Clinical Neurophysiology, Fornaca Clinic, Turin, ITA.
Research, Globus Medical Inc., Audubon, USA.
Cureus. 2024 Sep 9;16(9):e69007. doi: 10.7759/cureus.69007. eCollection 2024 Sep.
Objective This study assessed whether robotic-assisted navigation (RAN) spine surgery outcomes, including operative time and pedicle screw accuracy, continue to improve with extended experience beyond 200 cases. Methods This is a retrospective review of 60 patients who underwent lumbosacral transforaminal interbody fusion using RAN. Patients were segmented into three groups of 20 consecutive cases each. The first group represented a surgical performance baseline leading up to the investigating surgeon's 200th RAN case. The subsequent two groups were selected beyond the 200th case with an average of 15 cases between groups. Pedicle screw accuracy and intraoperative outcomes were assessed. Statistical results were significant if p<0.05. Results Measures of surgical efficiency significantly improved beyond the investigating surgeon's 200th RAN case. As case number increased, the following parameters significantly decreased: registration time (group 1: 16.9±6.5, group 2: 12.9±3.0, group 3: 8.7±1.6 minutes; p<0.05), screw insertion time (group 1: 14.9±3.5, group 2: 10.9±2.0, group 3: 8.4±2.7 minutes; p<0.05), and total operative time significantly decreased from group 1 (175.9±58.2 minutes) to group 2 (135.8±23.9 minutes) (p=0.013) with a non-significant decrease to group 3 (121.5±32.3 minutes). Accuracy (Grade = A) significantly increased across groups (group 1: 87%, group 2: 94%, group 3: 98%; p=0.024). Group 1 had the highest misplacement rate of 3.7% (4/108 screws). The overall misplacement rate was 1.4% (4/290 screws) (Grade C-E). There was a higher rate of lateral screw misplacement compared to medial misplacement. Conclusion Even with a small number of initial cases, RAN spine surgery can consistently be performed with high accuracy and acceptable intraoperative outcomes. However, this study demonstrated refined outcomes with extended robotic experience.
目的 本研究评估了机器人辅助导航（RAN）脊柱手术的效果，包括手术时间和椎弓根螺钉置入准确性，在超过200例手术的丰富经验下是否持续改善。方法 这是一项对60例行腰骶部经椎间孔椎间融合术的患者进行的回顾性研究，采用RAN技术。患者被连续分为三组，每组20例。第一组代表主刀医生第200例RAN手术之前的手术表现基线。随后两组选自第200例手术之后，两组之间平均间隔15例。评估椎弓根螺钉置入准确性和术中结果。若p<0.05，则统计结果具有显著性。结果 手术效率指标在主刀医生第200例RAN手术之后显著改善。随着病例数增加，以下参数显著降低：注册时间（第一组：16.9±6.5分钟，第二组：12.9±3.0分钟，第三组：8.7±1.6分钟；p<0.05），螺钉置入时间（第一组：14.9±3.5分钟，第二组：10.9±2.0分钟，第三组：8.4±2.7分钟；p<0.05），总手术时间从第一组（175.9±58.2分钟）显著降至第二组（135.8±23.9分钟）（p=0.013），降至第三组（121.5±32.3分钟）时无显著下降。准确性（A级）在各组间显著提高（第一组：87%，第二组：94%，第三组：98%；p=0.024）。第一组的误置率最高，为3.7%（108枚螺钉中有4枚）。总体误置率为1.4%（290枚螺钉中有4枚）（C-E级）。外侧螺钉误置率高于内侧。结论 即使初始病例数量较少，RAN脊柱手术也能始终以高精度和可接受的术中结果完成。然而，本研究表明随着机器人操作经验的增加，手术效果得到了优化。
