Robotically equipped 3D hybrid operating room in spine and trauma surgery - updated experience in 359 patients and...

Modern techniques, such as robotics and navigation, alongside cutting-edge imaging solutions like cone beam CT imaging, are playing an increasingly prominent role in spine and trauma surgery within so-called Hybrid ORs. This study aims to contribute to the ongoing scientific discussion surrounding accuracy rates and learning curves in the utilisation of a modern Hybrid OR. In a Level 1 trauma centre, a 3D Navigation-Hybrid OR was implemented, and a prospective data collection was launched (March 2022 - June 2025). Analysis was performed retrospectively. The Hybrid OR consists of a robotic cone beam CT "Loop-X", a robotic arm "Cirq Arm System", a navigation unit "Curve Navigation System", a wall-mounted monitor "BUZZ" and Elements Viewer 3D mixed reality glasses for planning (Brainlab, Munich, Germany). Intervention areas included the entire skeletal system, encompassing the spine, pelvis (pelvic ring and acetabulum), and extremities, with various indications, primarily trauma (fractures) and oncology (tumours). The focus of this study is to assess accuracy rates and learning curves. In n = 359 patients, 2080 screws were inserted. 1881 (90.4%) spinal screws were inserted with an accuracy rate (GR-A & GR-B) of 98.5% (CI95%: 97.9% - 99.0%). A total of 199 (9.6%) non-spinal screws were inserted with an accuracy rate of 99.0% (CI95%: 97.6% - 99.9%). The overall accuracy rate of screw placement was therefore 98.5% (CI95%: 98.0% - 99.0%). Minimally invasive techniques were used in 243 (67.7%) cases and the robotic arm was utilised in 271 (75.5%) cases. Subgroup analyses revealed a significant learning curve (p < 0.001) and a significant reduction in operation times over time (p = 0.008). Wound infection occurred in 10 (2.8%) cases, and 17 (4.7%) patients died during hospitalisation. This study demonstrates that a 3D-Navigation Hybrid OR can be successfully integrated into the clinical routine of a level 1 trauma centre. It shows promising results for interventions on the entire skeletal system, with consistently high accuracy rates and low complication rates. Furthermore, it highlights a significant learning curve and a significant reduction in operation times over time.