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An HSS examine examined the effectiveness of robot-assisted and augmented actuality surgical procedures. | Supply: Adobe Inventory
A examine on the Hospital for Particular Surgical procedure, or HSS, evaluating robot-assisted navigation to using augmented actuality in spinal surgical procedure discovered that each methods display glorious accuracy and security for pedicle screw placement.
Greater than 1.2 million spinal surgical procedures are carried out within the U.S. every year, based on the Nationwide Middle for Well being Statistics. Many of those procedures contain implants referred to as pedicle screws to stabilize the backbone, and exact positioning is crucial for a profitable surgical procedure.
“In comparison with typical free-hand methods, each robotic-assisted navigation [RAN] and using augmented actuality [AR] have demonstrated superior accuracy,” stated Darren R. Lebl, M.D., MBA. “Our examine is the primary to immediately evaluate RAN to AR with respect to screw placement precision.”
Lebl is a backbone surgeon and director of analysis at HSS, plus principal investigator of the examine. The analysis was revealed on-line within the journal Backbone.
HSS is a number one educational medical heart centered on musculoskeletal well being. Based in 1863, the New York-based healthcare supplier claimed it has the bottom readmission charges within the nation for orthopedics, in addition to among the lowest an infection and complication charges.
Along with affected person care, HSS stated it helps analysis, innovation, and training. The HSS Analysis Institute contains 20 laboratories and 300 workers members centered on advancing musculoskeletal well being by way of the prevention of degeneration, tissue restore, and tissue regeneration.
Darren R. Lebl is a backbone surgeon and director of analysis at HSS. | Supply: Hospital for Particular Surgical procedure
Robotic-assisted surgical procedure and AR provide help
Over the previous decade, quite a few robot-assisted navigation and augmented actuality techniques have emerged for backbone surgical procedure.
“Along with enhanced accuracy, the potential benefits of each applied sciences embrace decreased radiation publicity and supply for improved security in backbone surgical procedure,” famous Dr. Lebl. “A rising variety of main medical facilities nationwide are utilizing a minimum of one in every of these applied sciences.”
RAN entails robotic steerage of surgeon-operated devices. A robotic arm, together with 3D photographs of the affected person’s anatomy and navigation expertise much like GPS, allows the surgeon to carry out a minimally invasive process that’s deliberate forward of time on superior software program.
AR-assisted backbone surgical procedure superimposes 3D photographs of a affected person’s anatomy onto the surgeon’s visible subject throughout surgical procedure by way of a headset. A preoperative CT scan of the affected person’s backbone is used to plan and carry out the surgical procedure.
Research analyzes spinal surgical procedures
The HSS examine included 212 grownup backbone surgical procedure sufferers who had a complete of 1,211 pedicle screws positioned between June 2020 and October 2023. It adopted 108 individuals who acquired 827 screws utilizing robots and 104 sufferers who acquired 384 screws with augmented actuality.
They underwent surgical procedure within the lumbar and/or sacral backbone for degenerative spinal situations. One skilled surgeon carried out the entire robotic circumstances, whereas two different skilled backbone surgeons used the AR system.
The place of every pedicle screw was assessed after surgical procedure based mostly on both CT scan or 3D fluoroscopy utilizing the Gertzbein-Robbins classification system, which assigns a grade of A, B, C or D to guage accuracy. The HSS researchers thought-about Grades A and B to be acceptable.
The A score is assigned to screw placement utterly throughout the pedicle, a bony construction on the vertebra that protects the spinal twine. Grade B, nonetheless acceptable, is assigned to a screw that’s 2mm (1/16 inch) exterior of the specified location. Within the examine, any screw with a Grade C or D could be deemed unacceptable.
After surgical procedure, two impartial backbone surgeons assigned a grade to all of the pedicle screws. The examine discovered no important distinction between robot-assisted and AR screw placement by way of accuracy, with 99.6% of RAN screws rated as Grade A or B, and 98.7% of AR screws categorized as A or B. General, 92.6% of the screws achieved the highest Grade A score.
“Our outcomes confirmed glorious accuracy for each methods, making each robotics and AR secure instruments for correct positioning of lumbosacral pedicle screws,” Dr. Lebl stated. “Nevertheless, the next fee of Grade A screws was seen within the RAN group, doubtlessly highlighting superior precision for robotics.”
