Implementation of robot-assisted spine surgery in an academic center: workflow, learning curve and perspectives

Surgical robotics represent a significant advancement in healthcare, enhancing precision and safety in operative procedures. While widely used in neurosurgery, visceral surgery, and urology, its adoption in spinal surgery remains in development. This study reports the implementation of robotic-assisted spine surgery within a neurosurgical department, focusing on the learning curve, workflow integration, complications, and prospects. Successful integration requires a dedicated technical infrastructure and thorough training-both theoretical and practical-for the entire surgical team. Collaboration among surgeons, paramedical staff, and biomedical engineers is essential to optimize outcomes. We used a table-mounted robotic system (Mazor X Stealth Edition, Medtronic), with surgical planning based on preoperative, sub-millimetric bone-density CT scans to ensure personalized care. From November 2022 to May 2023, we included 32 patients with an average age of 58 y/o (SD 15 (19; 87)) for a total of 204 inserted screws. Degenerative spine represented the main indication followed by tumoral spine. Optimal accuracy for pedicle screw placement was 97 % corresponding to grade A (90.1%) and grade B (6.9%) from GRS. The operating time was of 186.7 min (SD 89.7 (45; 386)) and the average fluoroscopy time per screw was of 3.0 s (1.8-5.5). Installation is a time-consuming step. We observed a trend towards shorter operating times as more cases are operated on. No revision surgery was needed during the study period. Only 2 superficial skin infections were reported, with no other complication. Robotic spine surgery improves standardization, enhances accuracy, and promotes personalized medicine, with potential for further workflow optimization.