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Building consensus: development of a best practice guideline (BPG) for avoiding errors in robotic-assisted spine

Michael G Vitale1, Ritt R Givens2, Matan S Malka1

  • 1Division of Pediatric Orthopedics, Columbia University Medical Center, New York, NY, USA.

Spine Deformity
|March 3, 2025
PubMed
Summary

Experts developed 27 best practice guidelines to minimize errors in robotic-assisted spine surgery (RASS). These recommendations aim to reduce variability and enhance patient safety in RASS procedures.

Keywords:
Best practice guidelineDelphi processRobotic-assisted spine surgerySafety in spine surgery

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Area of Science:

  • Spine Surgery
  • Robotics in Medicine
  • Surgical Safety

Background:

  • Robotic-assisted spine surgery (RASS) is increasingly used, leading to a rise in reported complications.
  • Previous research identified and classified potential errors in technologically enhanced spine surgery.
  • There is a need for standardized best practices to improve patient safety in RASS.

Purpose of the Study:

  • To leverage expert opinion to develop best practice guidelines for RASS.
  • To minimize complications and optimize patient safety in robotic-assisted spine surgery.
  • To reduce practice variability in the application of RASS.

Main Methods:

  • A consensus-building approach using the Delphi method and nominal group technique.
  • Involved 12 experienced attending spine surgeons from across the United States.
  • Utilized iterative surveys, live discussions, and an in-person meeting to achieve ≥80% agreement on guidelines.

Main Results:

  • Achieved consensus on 27 best practice guideline statements after multiple iterative rounds.
  • Key focus areas include general protocols, screw planning/execution, surgical technique optimization, and robotic system improvements.
  • Guidelines are available at https://safetyinspinesurgery.com/.

Conclusions:

  • Presents expert-derived best practices for minimizing errors in RASS.
  • Offers 27 recommendations to reduce practice variability and optimize safety.
  • Provides a foundation for future research in robotic-assisted spine surgery.