Initial academic experience and learning curve with robotic spine instrumentation

Area of Science:

• Neurosurgery
• Robotics in Medicine
• Spinal Instrumentation

Background:

• Current robotic systems primarily assist with pedicle screw insertion in spine surgery.
• Evaluating robotic feasibility in an academic setting with resident involvement is crucial for training and adoption.

Purpose of the Study:

• To assess the feasibility and usability of robot-assisted pedicle instrumentation by neurosurgical residents and fellows in an academic environment.
• To evaluate the impact of trainee experience and case volume on the efficiency and accuracy of robot-assisted screw placement.

Main Methods:

• The Renaissance Guidance System was utilized for planning and executing pedicle screw placement in both open and percutaneous spine surgeries.
• Data on screw placement time, fluoroscopy duration, screw breaches, and complications were collected and analyzed retrospectively.
• Postoperative CT scans were used to assess the accuracy of screw placement.

Main Results:

• A total of 306 pedicle screws were placed in 30 patients using robotic guidance.
• No significant difference in screw placement time was observed between junior residents and senior residents/fellows (4.4 min/screw vs. 4.02 min/screw).
• Spine-dedicated residents showed a trend towards faster screw placement (3.84 min/screw) compared to non-dedicated residents (4.5 min/screw).

Conclusions:

• Robot-assisted pedicle instrumentation is feasible for neurosurgical trainees in an academic setting.
• While experience level did not significantly impact speed, a trend towards improved efficiency with increased case volume was noted.
• This study represents the first reported academic experience with robot-assisted spine instrumentation, highlighting potential pitfalls and areas for further investigation.