1
|
Nakdhamabhorn S, Pillai BM, Chotivichit A, Suthakorn J. Sensorless Based Haptic Feedback Integration In Robot-assisted Pedicle Screw Insertion For Lumbar Spine Surgery: A preliminary cadaveric study. Comput Struct Biotechnol J 2024; 24:420-433. [PMID: 38841212 PMCID: PMC11152607 DOI: 10.1016/j.csbj.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Pedicle screw fixation is an essential surgical technique for addressing various spinal pathologies, including degenerative diseases, trauma, tumors, neoplasms, and infections. Despite its efficacy, the procedure poses significant challenges, notably the limited visibility of spinal anatomical landmarks and the consequent reliance on surgeon's hand-eye coordination. These challenges often result in inaccuracies and high radiation exposure due to the frequent use of fluoroscopy X-ray guidance. Addressing these concerns, this study introduces a novel approach to pedicle screw insertion by utilizing a robot-assisted system that incorporates sensorless based haptics incorporated 5-DOF surgical manipulation. This innovative system aims to minimize radiation exposure and reduce operating time while improving the surgeon's hand posture capabilities. The developed prototype, expected to be implemented using bilateral control, was tested through preliminary cadaveric experiments focused on the insertion of both percutaneous and open pedicle screws at the L4-L5 level of the lumbar spine. Validation of the Sensorless Haptic Feedback feature was an integral part of this study, aiming to enhance precision and safety. The results, confirmed by fluoroscopic x-ray images, demonstrated the successful placement of two percutaneous and two open pedicle screws, with average position and torque errors of 0.011 radians and 0.054 Nm for percutaneous screws, and 0.0116 radians and 0.0057 Nm for open screws, respectively. These findings underscore the potential of the sensorless haptic feedback in a robot-assisted pedicle screw insertion system to significantly reduce radiation exposure and improve surgical outcomes, marking a significant advancement in spinal surgery technology.
Collapse
Affiliation(s)
- Sakol Nakdhamabhorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Areesak Chotivichit
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| |
Collapse
|
2
|
Wang C, Guo L, Zhu J, Zhu L, Li C, Zhu H, Song A, Lu L, Teng GJ, Navab N, Jiang Z. Review of robotic systems for thoracoabdominal puncture interventional surgery. APL Bioeng 2024; 8:021501. [PMID: 38572313 PMCID: PMC10987197 DOI: 10.1063/5.0180494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.
Collapse
Affiliation(s)
- Cheng Wang
- Hanglok-Tech Co. Ltd., Hengqin 519000, People's Republic of China
| | - Li Guo
- Hanglok-Tech Co. Ltd., Hengqin 519000, People's Republic of China
| | | | - Lifeng Zhu
- State Key Laboratory of Digital Medical Engineering, Jiangsu Key Lab of Remote Measurement and Control, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People's Republic of China
| | - Chichi Li
- School of Computer Science and Engineering, Macau University of Science and Technology, Macau, 999078, People's Republic of China
| | - Haidong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, People's Republic of China
| | - Aiguo Song
- State Key Laboratory of Digital Medical Engineering, Jiangsu Key Lab of Remote Measurement and Control, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People's Republic of China
| | | | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, People's Republic of China
| | | | - Zhongliang Jiang
- Computer Aided Medical Procedures, Technical University of Munich, Munich 80333, Germany
| |
Collapse
|
3
|
Lanza C, Carriero S, Buijs EFM, Mortellaro S, Pizzi C, Sciacqua LV, Biondetti P, Angileri SA, Ianniello AA, Ierardi AM, Carrafiello G. Robotics in Interventional Radiology: Review of Current and Future Applications. Technol Cancer Res Treat 2023; 22:15330338231152084. [PMID: 37113061 PMCID: PMC10150437 DOI: 10.1177/15330338231152084] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
This review is a brief overview of the current status and the potential role of robotics in interventional radiology. Literature published in the last decades, with an emphasis on the last 5 years, was reviewed and the technical developments in robotics and navigational systems using CT-, MR- and US-image guidance were analyzed. Potential benefits and disadvantages of their current and future use were evaluated. The role of fusion imaging modalities and artificial intelligence was analyzed in both percutaneous and endovascular procedures. A few hundred articles describing results of single or several systems were included in our analysis.
Collapse
Affiliation(s)
- Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Sveva Mortellaro
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Pierpaolo Biondetti
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Gianpaolo Carrafiello
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
4
|
Li C, Zhang T, Wang H, Hou Z, Zhang Y, Chen W. Advanced surgical tool: Progress in clinical application of intelligent surgical robot. SMART MEDICINE 2022; 1:e20220021. [PMID: 39188736 PMCID: PMC11235784 DOI: 10.1002/smmd.20220021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2024]
Abstract
Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.
Collapse
Affiliation(s)
- Chao Li
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Tongtong Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Haoran Wang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Zhiyong Hou
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| |
Collapse
|
5
|
Pojskić M, Bopp M, Nimsky C, Carl B, Saβ B. Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq ® Robotic Alignment: An Evaluation of the First 70 Screws. J Clin Med 2021; 10:jcm10245725. [PMID: 34945020 PMCID: PMC8703981 DOI: 10.3390/jcm10245725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab's Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). METHODS All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. RESULTS A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. CONCLUSION Brainlab's Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.
Collapse
Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Correspondence: ; Tel.: +49-642-1586-9848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
| | - Benjamin Saβ
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
| |
Collapse
|
6
|
Zhang W, Li H, Cui L, Li H, Zhang X, Fang S, Zhang Q. Research progress and development trend of surgical robot and surgical instrument arm. Int J Med Robot 2021; 17:e2309. [PMID: 34270175 DOI: 10.1002/rcs.2309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In recent years, surgical robots have become an indispensable part of the medical field. Surgical robots are increasingly being used in the areas of gynaecological surgery, urological surgery, orthopaedic surgery, general surgery and so forth. In this paper, the development of surgical robots in different operations is reviewed and analysed. In the type of master-slave surgical robotic system, the robotic surgical instrument arms were located in the execution terminal of a surgical robot system, as one of the core components, and directly contact with the patient during the operation, which plays an important role in the efficiency and safety of the operation. In clinical, the arm function and design in different systems varies. Furtherly, the current research progress of robotic surgical instrument arms used in different operations is analysed and summarised. Finally, the challenge and trend are concluded. METHODS According to the classification of surgical types, the development of surgical robots for laparoscopic surgery, neurosurgery, orthopaedics and microsurgery are analysed and summarised. Then, focusing on the research of robotic surgical instrument arms, according to structure type, the research and application of straight-rod surgical instrument arm, joint surgical instrument arm and continuous surgical instrument arm are analysed respectively. RESULTS According to the discussion and summary of the characteristics of the existing surgical robots and instrument arms, it is concluded that they still have a lot of room for development in the future. Therefore, the development trends of the surgical robot and instrument arm are discussed and analysed in the five aspects of structural materials, modularisation, telemedicine, intelligence and human-machine collaboration. CONCLUSION Surgical robots have shown the development trend of miniaturisation, intelligence, autonomy and dexterity. Thereby, in the field of science and technology, the research on the next generation of minimally invasive surgical robots will usher in a peak period of development.
Collapse
Affiliation(s)
- Wu Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Haiyuan Li
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Linlin Cui
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Haiyang Li
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Xiangyan Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Shanxiang Fang
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing, China
| | - Qinjian Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| |
Collapse
|
7
|
Li J, Wang Z, Zeng L, Liu Z, Hu W, Yu M. Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion. Clin Spine Surg 2021; 34:E466-E476. [PMID: 34050044 DOI: 10.1097/bsd.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A single-center randomized controlled study. OBJECTIVE The objective of this study was to introduce a novel robotic system with an independent arm ("Orthbot Intelligent Orthopedic Minimally Invasive System"; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation. SUMMARY OF BACKGROUND DATA Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement. MATERIALS AND METHODS A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG. RESULTS The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system. CONCLUSIONS The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.
Collapse
Affiliation(s)
| | - Zizhen Wang
- Department of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Lin Zeng
- Clinical Epidemiological Research Center, Peking University Third Hospital
| | | | - Wanheng Hu
- Department of Science and Technology Studies, Cornell University, Ithaca, NY
| | | |
Collapse
|
8
|
Unger M, Berger J, Melzer A. Robot-Assisted Image-Guided Interventions. Front Robot AI 2021; 8:664622. [PMID: 34322519 PMCID: PMC8312560 DOI: 10.3389/frobt.2021.664622] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022] Open
Abstract
Image guidance is a common methodology of minimally invasive procedures. Depending on the type of intervention, various imaging modalities are available. Common imaging modalities are computed tomography, magnetic resonance tomography, and ultrasound. Robotic systems have been developed to enable and improve the procedures using these imaging techniques. Spatial and technological constraints limit the development of versatile robotic systems. This paper offers a brief overview of the developments of robotic systems for image-guided interventions since 2015 and includes samples of our current research in this field.
Collapse
Affiliation(s)
- Michael Unger
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Johann Berger
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery, Leipzig, Germany.,Institute for Medical Science and Technology, IMSaT, University Dundee, Dundee, United Kingdom
| |
Collapse
|
9
|
Zhang J, Li W, Hu L, Yu Zhao, Wang T. A robotic system for spine surgery positioning and pedicle screw placement. Int J Med Robot 2021; 17:e2262. [PMID: 33837612 DOI: 10.1002/rcs.2262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND In recent years, surgeons have explored minimally invasive methods of percutaneous pedicle screw implantation which can effectively reduce human injuries. This article presents an accurate and efficient positioning method and robot system for percutaneous needle placement under c-arm fluoroscopy. METHODS A simple five degree of freedom (DOF) robot with a unique end-effector is designed to perform perspective calibration and image space registration. The principle of pedicle standard axis positioning is adopted to make the axis of the pedicle overlap with the x-ray axis of c-arm. RESULTS Then the clinical operation is carried out to verify the clinical feasibility of the designed robot and positioning method. The experimental results show that a total of 26 pedicle screws were accurately implanted. The accuracy of Grade A is 96.15%. The positioning time of a single guide pin is about 154.77 s, and three x-ray films need to be taken on average. CONCLUSIONS The positioning accuracy is increased by using the present method. In addition, this method is simple in operation, short in operation time, low in X-ray exposure.
Collapse
Affiliation(s)
- Jian Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Weishi Li
- Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing, China
| | - Lei Hu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yu Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Tianmiao Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| |
Collapse
|
10
|
Li J, Huang L, Zhou W, Wang Z, Li Z, Zeng L, Liu Z, Shen H, Cai Z, Gu H, Yang X, Zhang R, Hu W, Yu M, Chen J. Evaluation of a new spinal surgical robotic system of Kirschner wire placement for lumbar fusion: A multi-centre, randomised controlled clinical study. Int J Med Robot 2020; 17:e2207. [PMID: 33205847 DOI: 10.1002/rcs.2207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/19/2020] [Accepted: 11/16/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND To introduce a novel robotic system 'Orthbot' that has been developed and tested as a surgical assistant for auto-placement of the K-wire in lumbar fusion. METHODS This is a multi-centre, randomized controlled clinical study that includes 56 patients (robot group, RG: 27, free-hand group, FG: 29). Following the pre-operative planning and intra-operative fluoroscopic images, the 'Orthbot' automatically completed registration and K-wire placement under the supervision of the surgeon. Deviation distance (DD) and deviation angle (DA) were used as the primary parameters to evaluate the accuracy of the robotic system. RESULTS The average DD was 0.95 ± 0.377 mm and 4.35 ± 2.01 mm, respectively in the RG and FG (p < 0.001). The average DA of the K-wire in the coronal plane and the sagittal plane in X-Ray was respectively 6.80 ± 7.79° and 1.27 ± 2.32° in the RG (p < 0.001), and 22.22 ± 16.85° and 4.57 ± 3.86° in the FG (p < 0.001), which showed a higher accuracy rate in the robotic-assisted cases compared to the free-hand cases. CONCLUSIONS The novel robotic system could achieve accurate K-wire insertions as indicated by the radiological results.
Collapse
Affiliation(s)
- Junyu Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Lin Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Wenyu Zhou
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zizhen Wang
- Peking University Health Science Center, Beijing, China
| | - Zongze Li
- Department of Orthopedics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Lin Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Huiyong Shen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Zhaopeng Cai
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Hongsheng Gu
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xinjian Yang
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, China
| | - Rui Zhang
- Department of Orthopedics, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wanheng Hu
- Department of Science and Technology Studies, Cornell University, Ithaca, New York, USA
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jianting Chen
- Department of Orthopedics, Southern Medical University Nanfang Hospital, Guangzhou, China
| |
Collapse
|
11
|
Li W, Li G, Chen W, Cong L. The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease: a meta-analysis. Bone Joint Res 2020; 9:653-666. [PMID: 33101655 PMCID: PMC7547641 DOI: 10.1302/2046-3758.910.bjr-2020-0064.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims The aim of this study was to systematically compare the safety and accuracy of robot-assisted (RA) technique with conventional freehand with/without fluoroscopy-assisted (CT) pedicle screw insertion for spine disease. Methods A systematic search was performed on PubMed, EMBASE, the Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials (RCTs) that investigated the safety and accuracy of RA compared with conventional freehand with/without fluoroscopy-assisted pedicle screw insertion for spine disease from 2012 to 2019. This meta-analysis used Mantel-Haenszel or inverse variance method with mixed-effects model for heterogeneity, calculating the odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence intervals (CIs). The results of heterogeneity, subgroup analysis, and risk of bias were analyzed. Results Ten RCTs with 713 patients and 3,331 pedicle screws were included. Compared with CT, the accuracy rate of RA was superior in Grade A with statistical significance and Grade A + B without statistical significance. Compared with CT, the operating time of RA was longer. The difference between RA and CT was statistically significant in radiation dose. Proximal facet joint violation occurred less in RA than in CT. The postoperative Oswestry Disability Index (ODI) of RA was smaller than that of CT, and there were some interesting outcomes in our subgroup analysis. Conclusion RA technique could be viewed as an accurate and safe pedicle screw implantation method compared to CT. A robotic system equipped with optical intraoperative navigation is superior to CT in accuracy. RA pedicle screw insertion can improve accuracy and maintain stability for some challenging areas.Cite this article: Bone Joint Res 2020;9(10):653-666.
Collapse
Affiliation(s)
- Weishang Li
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Gaoyu Li
- Department of Obstetrics and Gynecology, Shengjing hospital of China Medical University, Shenyang, China
| | - Wenting Chen
- Disease Control and Prevention Center, China Railway Shenyang Bureau Group Corporation, Shengyang, China
| | - Lin Cong
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
12
|
Buza JA, Good CR, Lehman RA, Pollina J, Chua RV, Buchholz AL, Gum JL. Robotic-assisted cortical bone trajectory (CBT) screws using the Mazor X Stealth Edition (MXSE) system: workflow and technical tips for safe and efficient use. J Robot Surg 2020; 15:13-23. [DOI: 10.1007/s11701-020-01147-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
|
13
|
Burström G, Balicki M, Patriciu A, Kyne S, Popovic A, Holthuizen R, Homan R, Skulason H, Persson O, Edström E, Elmi-Terander A. Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study. Sci Rep 2020; 10:7522. [PMID: 32371880 PMCID: PMC7200720 DOI: 10.1038/s41598-020-64462-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
The combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. The robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable.
Collapse
Affiliation(s)
- Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | - Sean Kyne
- Philips Research North America, Cambridge, USA
| | | | - Ronald Holthuizen
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, the Netherlands
| | - Robert Homan
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, the Netherlands
| | - Halldor Skulason
- Department of Neurosurgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
14
|
Vo CD, Jiang B, Azad TD, Crawford NR, Bydon A, Theodore N. Robotic Spine Surgery: Current State in Minimally Invasive Surgery. Global Spine J 2020; 10:34S-40S. [PMID: 32528804 PMCID: PMC7263345 DOI: 10.1177/2192568219878131] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Robotic systems in spinal surgery may offer potential benefits for both patients and surgeons. In this article, the authors explore the future prospects and current limitations of robotic systems in minimally invasive spine surgery. METHODS We describe recent developments in robotic spine surgery and minimally invasive spine surgery. Institutional review board approval was not needed. RESULTS Although robotic application in spine surgery has been gradual, the past decade has seen the arrival of several novel robotic systems for spinal procedures, suggesting the evolution of technology capable of augmenting surgical ability. CONCLUSION Spine surgery is well positioned to benefit from robotic assistance and automation. Paired with enhanced navigation technologies, robotic systems have tremendous potential to supplement the skills of spine surgeons, improving patient safety and outcomes while limiting complications and costs.
Collapse
Affiliation(s)
- Chau D. Vo
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bowen Jiang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tej D. Azad
- Stanford University School of Medicine, Stanford, CA, USA
| | - Neil R. Crawford
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Ali Bydon
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
15
|
Fan M, Liu Y, He D, Han X, Zhao J, Duan F, Liu B, Tian W. Improved Accuracy of Cervical Spinal Surgery With Robot-Assisted Screw Insertion: A Prospective, Randomized, Controlled Study. Spine (Phila Pa 1976) 2020; 45:285-291. [PMID: 31568094 DOI: 10.1097/brs.0000000000003258] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, randomized, controlled trial. OBJECTIVE To compare robot-assisted and conventional implantation techniques by evaluating the accuracy and safety of implanting screws in cervical vertebrae. SUMMARY OF BACKGROUND DATA Cervical spinal surgery is difficult and dangerous as screw misplacement might lead not only to decreased stability but also neurological, vascular, and visceral injuries. A new robot-assisted surgical procedure has been introduced to improve the accuracy of implant screw positioning. METHODS We randomly assigned 135 patients with newly diagnosed cervical spinal disease and who required screw fixation using either robot-assisted or conventional fluoroscopy-assisted cervical spinal surgery. The primary outcomes were the discrepancies between the planned trajectories and the actual screw positions. RESULTS Altogether, 127 patients underwent the assigned intervention (61 robot-assisted and 66 conventional fluoroscopy-assisted). The baseline characteristics including the screw types, were similar in the two groups. Altogether, 390 screws were planed and placed in the cervical vertebrae, and 94.9% were acceptable. The robot-assisted group had a better screw placement accuracy than the conventional fluoroscopy-assisted group with associated P values <0.001 (0.83 [0.44, 1.29] vs. 1.79 [1.41, 2.50] mm). The Gertzbein and Robbins scales also showed a significant difference between the two groups (P < 0.001). Furthermore, the robot-assisted group experienced significantly less blood loss during surgery than the conventional fluoroscopy-assisted group (200 [50, 375] vs. 350 [100, 500] mL; P = 0.002) and shorter length of stay after surgery (P = 0.021). These two groups did not differ significantly regarding the duration of the operation (P = 0.525). Neurological injury occurred in one case in the conventional fluoroscopy-assisted group. CONCLUSION The accuracy and clinical outcomes of cervical spinal surgery using the robot-assisted technique tended to be superior to those with the conventional fluoroscopy-assisted technique in this prospective, randomized, controlled trial. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Han
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| |
Collapse
|
16
|
Jiang B, Azad TD, Cottrill E, Zygourakis CC, Zhu AM, Crawford N, Theodore N. New spinal robotic technologies. Front Med 2019; 13:723-729. [PMID: 31673935 DOI: 10.1007/s11684-019-0716-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/05/2019] [Indexed: 01/07/2023]
Abstract
Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly; however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time - issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.
Collapse
Affiliation(s)
- Bowen Jiang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Alex M Zhu
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | | | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
| |
Collapse
|
17
|
Li X, Zhang X, Deng C, Shang X, Zhang R, Zhang F, Zhang W. A new method for reducing operation time and radiation exposure in the placement of Jamshidi needles: Technical note. J Clin Neurosci 2019; 69:265-268. [PMID: 31473093 DOI: 10.1016/j.jocn.2019.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Percutaneous pedicle screws have been used in the treatment of thoracolumbar fractures for decades, and conventional fluoroscopy is commonly used to confirm the positions of the Jamshidi needles during the procedure. In this article, a modified method is reported for the placement of Jamshidi needles. The attending surgeons did not receive any radiation during the procedure and the fluoroscopy time for the patients was little. In our method, all six Jamshidi needles were placed on the pedicles and hammered 2 mm into each entry site. When the verification images were acquired, the medical personnel went behind a lead-lined wall. The positions of the needles were first reviewed and adjusted as needed based on the anterior-posterior (AP) image. Then, the C-arm was rotated and lateral images were obtained to further verify the needle placement. The rest of the screw placement procedure remained the same. The proposed technique was applied in 45 patients with thoracolumbar fractures. It took an average (range) of 5 (4-7) single-shot images to ensure all the needles were positioned at the ideal entry site and 12 (10-17) minutes to complete this step. No neurological symptoms were reported by the patients. Using the proposed technique, the radiation exposure for the surgeons is zero, and the patients are well-protected from excessive radiation exposure. This modified method of embedding all the Jamshidi needles at the entry sites before fluoroscopy is an improved technique compared with the conventional method.
Collapse
Affiliation(s)
- Xu Li
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Xianzuo Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Chen Deng
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Xifu Shang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Rui Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Feng Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China
| | - Wenzhi Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Hefei 230001, China.
| |
Collapse
|
18
|
Han X, Tian W, Liu Y, Liu B, He D, Sun Y, Han X, Fan M, Zhao J, Xu Y, Zhang Q. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine 2019; 30:615-622. [PMID: 30738398 DOI: 10.3171/2018.10.spine18487] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery. METHODS Patients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure. RESULTS A total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01). CONCLUSIONS TiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Xiaoguang Han
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Wei Tian
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yajun Liu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Bo Liu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Da He
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yuqing Sun
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Xiao Han
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Mingxing Fan
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Jingwei Zhao
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yunfeng Xu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Qi Zhang
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| |
Collapse
|
19
|
Alsalmi S, Capel C, Chenin L, Peltier J, Lefranc M. Robot-assisted intravertebral augmentation corrects local kyphosis more effectively than a conventional fluoroscopy-guided technique. J Neurosurg Spine 2019; 30:289-295. [PMID: 30544363 DOI: 10.3171/2018.8.spine18197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVEIntravertebral augmentation (IVA) is a reliable minimally invasive technique for treating Magerl type A vertebral body fractures. However, poor correction of kyphotic angulation, the risk of cement leakage, and significant exposure to radiation (for the surgeon, the operating room staff, and the patient) remain significant issues. The authors conducted a study to assess the value of robot-assisted IVA (RA-IVA) for thoracolumbar vertebral body fractures.METHODSThe authors performed a retrospective, single-center study of patients who had undergone RA-IVA or conventional fluoroscopy-guided IVA (F-IVA) for thoracolumbar vertebral body fractures. Installation and operating times, guidance accuracy, residual local kyphosis, degree of restoration of vertebral body height, incidence of cement leakage, rate of morbidity, length of hospital stay, and radiation-related data were recorded.RESULTSData obtained in 30 patients who underwent RA-IVA were compared with those obtained in 30 patients who underwent F-IVA during the same period (the surgical indications were identical, but the surgeons were different). The mean ± SD installation time in the RA-IVA group (24 ± 7.5 minutes) was significantly shorter (p = 0.005) than that in the F-IVA group (26 ± 8 minutes). The mean operating time for the RA-IVA group (52 ± 11 minutes) was significantly longer (p = 0.026) than that for the F-IVA group (30 ± 11 minutes). All RA-IVAs and F-IVAs were Ravi's scale grade A (no pedicle breach). The mean degree of residual local kyphosis (4.7° ± 3.15°) and the percentage of vertebral body height restoration (63.6% ± 21.4%) were significantly better after RA-IVA than after F-IVA (8.4° ± 5.4° and 30% ± 34%, respectively). The incidence of cement leakage was significantly lower in the RA-IVA group (p < 0.05). The mean length of hospital stay after surgery was 3.2 days for both groups. No surgery-related complications occurred in either group. With RA-IVA, the mean radiation exposure was 438 ± 147 mGy × cm for the patient and 30 ± 17 mGy for the surgeon.CONCLUSIONSRA-IVA provided better vertebral body fracture correction than the conventional F-IVA. However, RA-IVA requires more time than F-IVA.
Collapse
|
20
|
Chen AF, Kazarian GS, Jessop GW, Makhdom A. Robotic Technology in Orthopaedic Surgery. J Bone Joint Surg Am 2018; 100:1984-1992. [PMID: 30480604 DOI: 10.2106/jbjs.17.01397] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory S Kazarian
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Galen W Jessop
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Asim Makhdom
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Siasios ID, Pollina J, Khan A, Dimopoulos VG. Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system. JOURNAL OF SPINE SURGERY 2017; 3:657-665. [PMID: 29354745 DOI: 10.21037/jss.2017.12.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several guidance techniques have been employed to increase accuracy and reduce surgical time during percutaneous placement of pedicle screws (PS). The purpose of our study was to present a modified technique for percutaneous placement of lumbar PS that reduces surgical time. We reviewed 23 cases of percutaneous PS placement using our technique for minimally invasive lumbar surgeries and 24 control cases where lumbar PS placement was done via common technique using Jamshidi needles (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). An integrated computer-guided navigation system was used in all cases. In the technique modification, a handheld drill with a navigated guide was used to create the path for inserting guidewires through the pedicles and into the vertebral bodies. After drill removal, placement of the guidewires through the pedicles took place. The PS were implanted over the guidewires, through the pedicles and into the vertebral bodies. Intraoperative computed tomography was performed after screw placement to ensure optimal positioning in all cases. There were no intraoperative complications with either technique. PS placement was correct in all cases. The average time for each PS placement was 6.9 minutes for the modified technique and 9.2 minutes for the common technique. There was no significant difference in blood loss. In conclusion, this modified technique is efficient and contributes to reduced operative time.
Collapse
Affiliation(s)
- Ioannis D Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Vassilios George Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| |
Collapse
|
22
|
A 6-DOF parallel bone-grinding robot for cervical disc replacement surgery. Med Biol Eng Comput 2017; 55:2107-2121. [PMID: 28536978 DOI: 10.1007/s11517-017-1648-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
Artificial cervical disc replacement surgery has become an effective and main treatment method for cervical disease, which has become a more common and serious problem for people with sedentary work. To improve cervical disc replacement surgery significantly, a 6-DOF parallel bone-grinding robot is developed for cervical bone-grinding by image navigation and surgical plan. The bone-grinding robot including mechanical design and low level control is designed. The bone-grinding robot navigation is realized by optical positioning with spatial registration coordinate system defined. And a parametric robot bone-grinding plan and high level control have been developed for plane grinding for cervical top endplate and tail endplate grinding by a cylindrical grinding drill and spherical grinding for two articular surfaces of bones by a ball grinding drill. Finally, the surgical flow for a robot-assisted cervical disc replacement surgery procedure is present. The final experiments results verified the key technologies and performance of the robot-assisted surgery system concept excellently, which points out a promising clinical application with higher operability. Finally, study innovations, study limitations, and future works of this present study are discussed, and conclusions of this paper are also summarized further. This bone-grinding robot is still in the initial stage, and there are many problems to be solved from a clinical point of view. Moreover, the technique is promising and can give a good support for surgeons in future clinical work.
Collapse
|
23
|
Lefranc M, Peltier J. Evaluation of the ROSA™ Spine robot for minimally invasive surgical procedures. Expert Rev Med Devices 2016; 13:899-906. [DOI: 10.1080/17434440.2016.1236680] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M. Lefranc
- Department of Neurosurgery, Amiens University Medical Center, Amiens, France
| | - J. Peltier
- Department of Neurosurgery, Amiens University Medical Center, Amiens, France
| |
Collapse
|