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Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to clarify the learning curve for robotic-assisted spine surgery. We analyzed the workflow in robotic-assisted spine surgery and investigated how much experience is required to become proficient in robotic-assisted spine surgery.

Methods

The data were obtained from consecutive 125 patients who underwent robotic-assisted screw placement soon after introducing a spine robotic system at a single center from April 2021 to January 2023. The 125 cases were divided into phases 1–5 of sequential groups of 25 cases each and compared for screw insertion time, robot setting time, registration time, and fluoroscopy time.

Results

There were no significant differences in age, body mass index, intraoperative blood loss, number of fused segments, operation time, or operation time per segment between the 5 phases. There were significant differences in screw insertion time, robot setting time, registration time, and fluoroscopy time between the 5 phases. The screw insertion time, robot setting time, registration time, and fluoroscopy time in phase 1 were significantly longer than those in phases 2, 3, 4, and 5.

Conclusion

In an analysis of 125 cases after the introduction of the spine robotic system, the screw insertion time, robot setting time, registration time, and fluoroscopy time were significantly longer in the 25 cases in the period initially after introduction. The times were not significantly different in the subsequent 100 cases. Surgeons can be proficient in robotic-assisted spine surgery after their experience with 25 cases.

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References

  1. Fatima N, Massaad E, Hadzipasic M et al (2021) Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J 21:181–192. https://doi.org/10.1016/j.spinee.2020.09.007

    Article  PubMed  Google Scholar 

  2. Roser F, Tatagiba M, Maier G (2013) Spinal robotics: current applications and future perspectives. Neurosurgery 72(Suppl 1):12–18. https://doi.org/10.1227/NEU.0b013e318270d02c

    Article  PubMed  Google Scholar 

  3. Akazawa T, Torii Y, Ueno J et al (2023) Accuracy of computer-assisted pedicle screw placement for adolescent idiopathic scoliosis: a comparison between robotics and navigation. Eur Spine J 32:651–658. https://doi.org/10.1007/s00586-022-07502-6

    Article  PubMed  Google Scholar 

  4. Mao G, Gigliotti MJ, Myers D et al (2020) Single-surgeon direct comparison of O-arm neuronavigation versus Mazor X robotic-guided posterior spinal instrumentation. World Neurosurg 137:e278–e285. https://doi.org/10.1016/j.wneu.2020.01.175

    Article  PubMed  Google Scholar 

  5. Khan A, Meyers JE, Siasios I et al (2019) Next-generation robotic spine surgery: first report on feasibility, safety, and learning curve. Oper Neurosurg (Hagerstown) 17:61–69. https://doi.org/10.1093/ons/opy280

    Article  PubMed  Google Scholar 

  6. Hu X, Lieberman IH (2014) What is the learning curve for robotic-assisted pedicle screw placement in spine surgery? Clin Orthop Relat Res 472:1839–1844. https://doi.org/10.1007/s11999-013-3291-1

    Article  PubMed  Google Scholar 

  7. Kam JKT, Gan C, Dimou S, Awad M, Kavar B, Nair G, Morokoff A (2019) Learning curve for robot-assisted percutaneous pedicle screw placement in thoracolumbar surgery. Asian Spine J 13(6):920–927. https://doi.org/10.31616/asj.2019.0033

    Article  PubMed  PubMed Central  Google Scholar 

  8. BÄcker HC, Freibott CE, Perka C et al (2020) Surgeons’ learning curve of renaissance robotic surgical system. Int J Spine Surg 14:818–823. https://doi.org/10.14444/7116

    Article  PubMed  PubMed Central  Google Scholar 

  9. Avrumova F, Morse KW, Heath M et al (2021) Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes. Spine Surg 7:141–154. https://doi.org/10.21037/jss-20-687

    Article  Google Scholar 

  10. Hyun S-J, Kim K-J, Jahng T-A, Kim H-J (2017) Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine 42(6):353–358. https://doi.org/10.1097/BRS.0000000000001778

    Article  PubMed  Google Scholar 

  11. Kim HJ, Jung WI, Chang BS et al (2017) A prospective, randomized, controlled trial of robot-assisted vs. freehand pedicle screw fixation in spine surgery. Int J Med Robotics Comput Assist Surg 13:e1779. https://doi.org/10.1002/rcs.1779

    Article  Google Scholar 

  12. Siddiqui MI, Wallace DJ, Salazar LM et al (2019) Robot-assisted pedicle screw placement: learning curve experience. World Neurosurg 130:e417–e422. https://doi.org/10.1016/j.wneu.2019.06.107

    Article  PubMed  Google Scholar 

  13. Torii Y, Ueno J, Iinuma M et al (2022) The learning curve of robotic-assisted pedicle screw placements using the cumulative sum analysis: a study of the first 50 cases at a single center. Spine Surg Relat Res 6:589–595. https://doi.org/10.22603/ssrr.2022-0049

    Article  PubMed  PubMed Central  Google Scholar 

  14. Torii Y, Ueno J, Umehara T et al (2022) Screw insertion time, fluoroscopy time, and operation time for robotic-assisted lumbar pedicle screw placement compared with freehand technique. Cureus 14:e25039. https://doi.org/10.7759/cureus.25039

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhang Q, Xu YF, Tian W et al (2019) Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg 11:850–856. https://doi.org/10.1111/os.12534

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yu J, Zhang Q, Fan MX et al (2021) Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test. World J Clin Cases 9:10134–10142. https://doi.org/10.12998/wjcc.v9.i33.10134

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by the Grants-in-Aid for Scientific Research of Japan Society for the Promotion of Science, Grant Number JP21K09311.

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Author notes

  1. Tsutomu Akazawa

    Present address: Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

Authors and Affiliations

  1. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yoshiaki Torii, Jun Ueno, Tasuku Umehara, Masahiro Iinuma, Atsuhiro Yoshida, Ken Tomochika & Hisateru Niki

  2. Spine Center, St. Marianna University Hospital, Kawasaki, Japan

    Tsutomu Akazawa, Yoshiaki Torii, Jun Ueno, Atsuhiro Yoshida & Ken Tomochika

  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Seiji Ohtori

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Contributions

TA wrote and prepared the manuscript. All authors participated in the study design. All authors have read, reviewed, and approved the article.

Corresponding author

Correspondence to Tsutomu Akazawa.

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Conflict of interest

Tsutomu Akazawa received research grants from Medtronic and Globus Medical. Tsutomu Akazawa received honoraria from Medtronic. The other authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Institutional review board of St. Marianna University School of Medicine (Approval code No. 6019).

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Akazawa, T., Torii, Y., Ueno, J. et al. Learning curves for robotic-assisted spine surgery: an analysis of the time taken for screw insertion, robot setting, registration, and fluoroscopy. Eur J Orthop Surg Traumatol 34, 127–134 (2024). https://doi.org/10.1007/s00590-023-03630-x

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  • DOI: https://doi.org/10.1007/s00590-023-03630-x

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