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Maman D, Mahamid A, Finkel B, Gan-Or H, Fournier L, Berkovich Y, Behrbalk E. Comparative evaluation of postoperative outcomes and expenditure between robotic and conventional single-level lumbar fusion surgery: a comprehensive analysis of nationwide inpatient sample data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2637-2645. [PMID: 38713445 DOI: 10.1007/s00586-024-08273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION In this study, we investigate the evolution of lumbar fusion surgery with robotic assistance, specifically focusing on the impact of robotic technology on pedicle screw placement and fixation. Utilizing data from the Nationwide Inpatient Sample (NIS) covering 2016 to 2019, we conduct a comprehensive analysis of postoperative outcomes and costs for single-level lumbar fusion surgery. Traditionally, freehand techniques for pedicle screw placement posed risks, leading to the development of robotic-assisted techniques with advantages such as reduced misplacement, increased precision, smaller incisions, and decreased surgeon fatigue. However, conflicting study results regarding the efficacy of robotic assistance in comparison to conventional techniques have prompted the need for a thorough evaluation. With a dataset of 461,965 patients, our aim is to provide insights into the impact of robotic assistance on patient care and healthcare resource utilization. Our primary goal is to contribute to the ongoing discourse on the efficacy of robotic technology in lumbar fusion procedures, offering meaningful insights for optimizing patient-centered care and healthcare resource allocation. METHODS This study employed data from the Nationwide Inpatient Sample (NIS) spanning the years 2016 to 2019 from USA, 461,965 patients underwent one-level lumbar fusion surgery, with 5770 of them having the surgery with the assistance of robotic technology. The study focused primarily on one-level lumbar fusion surgery and excluded non-elective cases and those with prior surgeries. The analysis encompassed the identification of comorbidities, surgical etiologies, and complications using specific ICD-10 codes. Throughout the study, a constant comparison was made between robotic and non-robotic lumbar fusion procedures. Various statistical methods were applied, with a p value threshold of < 0.05, to determine statistical significance. RESULTS Robotic-assisted lumbar fusion surgeries demonstrated a significant increase from 2016 to 2019, comprising 1.25% of cases. Both groups exhibited similar patient demographics, with minor differences in payment methods, favoring Medicare in non-robotic surgery and more private payer usage in robotic surgery. A comparison of comorbid conditions revealed differences in the prevalence of hypertension, dyslipidemia, and sleep apnea diagnoses-In terms of hospitalization outcomes and costs, there was a slight shorter hospital stay of 3.06 days, compared to 3.13 days in non-robotic surgery, showcasing a statistically significant difference (p = 0.042). Robotic surgery has higher charges, with a mean charge of $154,673, whereas non-robotic surgery had a mean charge of $125,467 (p < 0.0001). Robotic surgery demonstrated lower rates of heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury compared to non-robotic surgery, with statistically significant differences (p < 0.05). Conversely, robotic surgery demonstrated increased post-surgery anemia and blood transfusion requirements compared to non-robotic patients (p < 0.0001). Renal disease prevalence was similar before surgery, but acute kidney injury was slightly higher in the robotic group post-surgery (p = 0.038). CONCLUSION This is the first big data study on this matter, our study showed that Robotic-assisted lumbar fusion surgery has fewer post-operative complications such as heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury in comparison to conventional methods. Conversely, robotic surgery demonstrated increased post-surgery anemia, blood transfusion and acute kidney injury. Robotic surgery has higher charges compared to non-robotic surgery.
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Affiliation(s)
- David Maman
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel.
| | - Assil Mahamid
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Binyamin Finkel
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Hadar Gan-Or
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | | | - Yaron Berkovich
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Behrbalk
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
- Technion Israel Institute of Technology, Haifa, Israel
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Cui W, Liu X, Zhao Z, Feng Z, Meng X. Accuracy and postoperative assessment of robot-assisted placement of pedicle screws during scoliosis surgery compared with conventional freehand technique: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:365. [PMID: 38902785 PMCID: PMC11188284 DOI: 10.1186/s13018-024-04848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. BACKGROUND The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement. METHODS A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications. RESULTS Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75-3.91, P < 0.0001). However, there were no statistically significant differences in achieving "perfect" screw placement between the two groups (OR: 1.52, 95% CI: 0.95-2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25-64.74, P < 0.0001) but shorter postoperative hospital stays (MD: - 1.12, 95% CI: - 2.15 to - 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation. CONCLUSION Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss.
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Affiliation(s)
- Wei Cui
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xinglin Liu
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zhiheng Zhao
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zihe Feng
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, S Sanlitun Rd, Chaoyang District, Beijing, 100020, China
| | - Xianglong Meng
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Xie LZ, Wang QL, Zhang Q, He D, Tian W. Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis. J Orthop Surg Res 2023; 18:243. [PMID: 36966314 PMCID: PMC10039560 DOI: 10.1186/s13018-023-03714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 03/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND With the popularization of robot-assisted spinal surgeries, it is still uncertain whether robots with different designs could lead to different results in the accuracy of pedicle screw placement. This study aimed to compare the pedicle screw inserting accuracies among the spinal surgeries assisted by various types of robot and estimate the rank probability of each robot-assisted operative technique involved. METHODS The electronic literature database of PubMed, Web of Science, EMBASE, CNKI, WANFANG and the Cochrane Library was searched in November 2021. The primary outcome was the Gertzbein-Robbins classification of pedicle screws inserted with various operative techniques. After the data extraction and direct meta-analysis process, a network model was established in the Bayesian framework and further analyses were carried out. RESULTS Among all the 15 eligible RCTs, 4 types of robot device, namely Orthbot, Renaissance, SpineAssist and TiRobot, were included in this study. In the network meta-analysis, the Orthbot group (RR 0.27, 95% CI 0.13-0.58), the Renaissance group (RR 0.33, 95% CI 0.14-0.86), the SpineAssist group (RR 0.14, 95% CI 0.06-0.34) and the conventional surgery group (RR 0.21, 95% CI 0.13-0.31) were inferior to the TiRobot group in the proportion of grade A pedicle screws. Moreover, the results of rank probabilities revealed that in terms of accuracy, the highest-ranked robot was TiRobot, followed by Renaissance and Orthbot. CONCLUSIONS In general, current RCT evidence indicates that TiRobot has an advantage in the accuracy of the pedicle screw placement, while there is no significant difference among the Orthbot-assisted technique, the Renaissance-assisted technique, the conventional freehand technique, and the SpineAssist-assisted technique in accuracy.
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Affiliation(s)
- Lin-Zhen Xie
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi-Long Wang
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhang
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Da He
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
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Matur AV, Palmisciano P, Duah HO, Chilakapati SS, Cheng JS, Adogwa O. Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws: a systematic review and meta-analysis. Spine J 2023; 23:197-208. [PMID: 36273761 DOI: 10.1016/j.spinee.2022.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND CONTEXT Navigated and robotic pedicle screw placement systems have been developed to improve the accuracy of screw placement. However, the literature comparing the safety and accuracy of robotic and navigated screw placement with fluoroscopic freehand screw placement in thoracolumbar spine surgery has been limited. PURPOSE To perform a systematic review and meta-analysis of randomized control trials that compared the accuracy and safety profiles of robotic and navigated pedicle screws with fluoroscopic freehand pedicle screws. STUDY DESIGN/SETTING Systematic review and meta-analysis PATIENT SAMPLE: Only randomized controlled trials comparing robotic-assisted or navigated pedicle screws placement with freehand pedicle screw placement in the thoracolumbar spine were included. OUTCOME MEASURES Odds ratio (OR) estimates for screw accuracy according to the Gertzbein-Robbins scale and relative risk (RR) for various surgical complications. METHODS We systematically searched PubMed and EMBASE for English-language studies from inception through April 7, 2022, including references of eligible articles. The search was conducted according to PRISMA guidelines. Two reviewers conducted a full abstraction of all data, and one reviewer verified accuracy. Information was extracted on study design, quality, bias, participants, and risk estimates. Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. RESULTS A total of 14 papers encompassing 12 randomized controlled trials were identified (n=892 patients, 4,046 screws). The pooled analysis demonstrated that robotic and navigated pedicle screw placement techniques were associated with higher odds of screw accuracy (OR 2.66, 95% CI 1.24-5.72, p=.01). Robotic and navigated screw placement was associated with a lower risk of facet joint violations (RR 0.09, 95% CI 0.02-0.38, p<.01) and major complications (RR 0.31, 95% CI 0.11-0.84, p=.02). There were no observed differences between groups in nerve root injury (RR 0.50, 95% CI 0.11-2.30, p=.37), or return to operating room for screw revision (RR 0.28, 95% CI 0.07-1.13, p=.07). CONCLUSIONS These estimates suggest that robotic and navigated screw placement techniques are associated with higher odds of screw accuracy and superior safety profile compared with fluoroscopic freehand techniques. Additional randomized controlled trials will be needed to further validate these findings.
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Affiliation(s)
- Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Henry O Duah
- Department of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | | | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45229, USA.
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Huang J, Xing T, Cheng Z, Lu S, Li M, Liang Y, Huang J, Liao Z, Su K, Wen G, Liang C, Che Z, Chen E, Chen J, Zhu S, Sun D, Li Y, Huang L. AOSRV: Development and preliminary performance assessment of a new robotic system for autonomous percutaneous vertebroplasty. Int J Med Robot 2022; 18:e2456. [DOI: 10.1002/rcs.2456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Junshen Huang
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Tong Xing
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
- Department of Orthopedics The Eighth Affiliated Hospital, Sun Yat‐sen University Shenzhen China
| | - Ziying Cheng
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Shixin Lu
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Ming Li
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Yuwei Liang
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Jiajun Huang
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Zhuangyao Liao
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Kaihui Su
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Guoming Wen
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Changchun Liang
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Zhen Che
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Enming Chen
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Jiarui Chen
- Shenzhen Futurtec Medical Co.,Ltd Shenzhen China
| | | | - Donghui Sun
- Shenzhen Futurtec Medical Co.,Ltd Shenzhen China
| | - Yuxi Li
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
- Nanchang Research Institute of Sun Yat‐sen University Nanchang China
| | - Lin Huang
- Department of Orthopedics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
- Nanchang Research Institute of Sun Yat‐sen University Nanchang China
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Robot-assisted knee arthroplasty improves component positioning and alignment, but results are inconclusive on whether it improves clinical scores or reduces complications and revisions: a systematic overview of meta-analyses. Knee Surg Sports Traumatol Arthrosc 2022; 30:2639-2653. [PMID: 33666686 DOI: 10.1007/s00167-021-06472-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic overview was to identify, synthesise and critically appraise findings of meta-analyses on robot-assisted versus conventional unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The hypothesis was that robotic assistance would reduce complications and revision rates, yield better clinical scores, and improve component positioning and alignment. METHODS Two researchers independently conducted a literature search using Embase®, MEDLINE®, Web of Science, Allied and Complementary Medicine™ and Cochrane Database of Systematic Reviews on 2 November 2020 for meta-analyses (Level I-IV) on robotic assistance in UKA and/or TKA. Outcomes were tabulated and reported as weighted mean difference (WMD), risk ratio (RR) or weighted odds ratio (WOR), and were considered statistically significant when p < 0.05. RESULTS A total of ten meta-analyses were identified; four on robot-assisted UKA (n, 1880 robot-assisted vs. 2352 conventional UKA; follow-up, 0 to 60 months), seven on robot-assisted TKA (n, 4567 robot-assisted vs. 5966 conventional TKA; follow-up, 0 to 132 months). Of the meta-analyses on UKA, one found that robotic assistance reduced complication rates (relative risk (RR), 0.62), one found that it improved clinical scores (weighted mean difference (WMD), 19.67), three found that it extended operation times (WMD, 15.7 to 17.1 min), and three found that it improved component positioning and alignment (WMD, - 1.30 to - 3.02 degrees). Of the meta-analyses on TKA, two found that robotic assistance improved clinical scores (WMD, 1.62-1.71), two found that that it extended surgery times (WMD, 21.5-24.26 min), and five found that it improved component positioning and alignment (WMD, - 0.50 to - 10.07 degrees). None of the meta-analyses reported differences in survivorship between robot-assisted versus conventional knee arthroplasty. CONCLUSION Robot-assisted knee arthroplasty enabled more accurate component positioning and placement within target zones, but extended operation time considerably. Although robotic assistance improved component positioning, its benefits regarding clinical scores, patient satisfaction and implant survivorship remains to be confirmed. Finally, this overview revealed that six of the ten meta-analyses were of 'critically low quality', calling for caution when interpreting results. LEVEL OF EVIDENCE IV.
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