Robotic Spine Surgery - Advantages and Disadvantages

Introduction

Robotic spinal surgery, also known as robot-assisted spinal surgery, was approved for the first time by the FDA (Food and Drug Administration) in 2004 by an Israeli company named Mazor Robotics Ltd. The robot-assisted surgeries are done to provide high-precision treatment under minimal tissue invasion. Robotic surgeries show a steady hand and expert tissue navigation while performing the surgery. It also increases the accuracy along with lesser operation time, radiation exposure, postoperative complications, and recovery period. Although robotic spinal surgery is restricted only to spinal fusion and instrumentation treatments, it is also recently trialed in tumor resection and ablation of the spine and correction of deformities in the shape of the vertebral column.

Robotic surgery had a long and slow growth of origin as the approval of robots in the medical field was not readily accepted. Still, despite the disapproving mindset, the programmable universal machine for assembly 560 (PUMA 560) came up with the very first surgical robot for brain biopsy, which showed improved and precise techniques back then. And today, robotic surgery is performed in many fields of medicine like general surgery, gynecology, and urology. Although robotics has been performed since 1985, robotic spine surgery is a newer entity approved recently in 2004 by the FDA.

What Are the Advantages of Robotic Spine Surgery?

Following are some of the advantages of robotic spine surgery:

• Better access.

• Easy navigation.

• Less blood loss.

• Less pain.

• Less tissue trauma.

• Better postoperative immune system.

• Quicker healing time.

• Less intraoperative complications.

What Are the Disadvantages of Robotic Spine Surgery?

The following are some of the disadvantages of robotic spine surgery:

• The present-day robots lack tactile sensitivity.

• Technical knowledge requires a sound, new learning system, and an extra surgical team.

• Higher cost expenditure.

• Limited or minor procedures due to lack of evidence.

How Is Robotic Spine Surgery Operated?

Robotic surgery is operated by a computer-aided navigation system (CAN), which means the computer or the robot helps the surgeon identify accesses to the site of injury or defect and helps in easy operation. This system gives three-dimensional imaging allowing for easy visualization and navigation. CAN and CT (Computed Tomography) enable surgeons to work with precision. The CAN system is greatly used for procedures like removing spinal tumors or for correcting the spinal deformity.

The types of software systems that function with CAN systems that are available for surgeons to operate are:

• The Stryker spinal navigation with the spine map software.

• Air mobile intraoperative computed tomography-based navigation system.

• Stealth station spine surgery imaging and surgical navigation system.

• Ziehm Vision FD Vario 3-D system with naviport integration.

What Are the Robots Currently Available?

Medical robots can be classified into three categories depending on the mode of operation

• Supervisory-Controlled Robots -This group of robots allows surgeons to preplan the operative techniques before surgery. Here the robots perform the surgery by themselves under the surgeon's supervision. Because the instructions have to be pre-fed in the robot, each time the surgeon has to feed the details in, which can be very time-consuming and expensive.

• Telesurgical Robots - These types of robots are also called remote robots. These robots allow surgeons to work directly by controlling the robot while performing the surgery. Here both the robot and the instruments are operated on by the surgeon.

• Shared Control Robots - This robotic system has the most surgeon involvement. The surgeon performs the procedure, and the robot offers a steady hand to perform the surgery. Because this method allows the doctor and the robot to operate jointly, it is called a shared control robot.

What Are the Robots Used to Perform Spinal Surgery?

The FDA has approved six different robots to perform spinal surgery; they are :

1. Mazor- Spine Assist: It was the first robot approved by the FDA to perform surgery in 2004 and is one of the most widely used robots around the globe. It works on the principle of the CAN system approach. This robot can automatically position itself along the direction of the determined path.

2. Mazor- Renaissance: It is a second-generation spinal robot succeeding spine assist. This robot came into existence in the year 2011. The Renaissance robot has improved efficiency, including both software and hardware systems.

3. Mazor- Mazor X: This robot was introduced by the North American Spine Society (NASS) in 2016. Unlike the previous two systems, it has an optic camera attached to the linear hand of the robot. It registers each vertebral body individually, enabling Mazor to perform independently with high accuracy.

4. ROSA Spine: This robot was designed based on ROSA Brain, designed to perform head surgeries in 2012. This robot came into existence in the year 2016 approved by the FDA. The robot enables the surgeons to merge the pre and intra-operative scans to plan the surgery path. However, the ROSA Spine robot has certain limitations. It has a very intense learning curve and requires well-experienced surgeons to operate.

5. Intuitive Surgical- Da Vinci Surgical System - This robot was developed in 2000 and performed using the telesurgical model. This robot gives superior visualization, greater magnification, a more controlled grip, high-clarity videos, and improved outcomes. But this has a more extensive body setup than the other robots.

6. Globus Medical- Excelsius Gps -This robot was approved in 2017 and had supreme efficacy in spinal surgery. It is automatic with good intraoperative imaging and precise techniques. While the robot is similar to ROSA and Mazor, it is still under research confirming its effectiveness.

What Are the Clinical Outcomes and Accuracy of Robotic Surgery?

Robotic surgery shows greater accuracy compared to conventional methods. The screw placements in spinal surgery showed a 98.9 % success rate. The procedure shows higher efficiency rates than fluoroscopy. Robotic surgery shows a drastic decrease in radiation. The operating time taken for performing the surgery is considerably reduced.

What Are the Factors Affecting the Outcomes and Accuracy of Robotic Surgery?

The factors that affect the outcome of the surgery can be systemic and mechanical.

• The systemic factors include:

  • The body mass index (BMI).

  • The severity of the deformity.

  • Poor bone density.

  • Autoimmune diseases like HIV (human immunodeficiency virus).

• The mechanical factors include:

  • Difficulty in screw placements.

  • Previously loosened screws.

  • Device errors.

Conclusion

Studies show that almost 40 % of adults over 40 years suffer from spinal disorders, and operating them can be crucial and time-consuming. With the improved quantity of medicine and technology, robot-assisted spinal surgery shows greater accuracy, precision, and successful outcomes in a short time. The precision of performance in robotic surgery is almost 98.9 %, according to the studies. Although robotic surgery is still under research and trials for improvement, robotic spine surgeries are beneficial to patients with very minor to no postoperative complications and should be appreciated.