Surgical Robotics and Spinal Surgery: Looking Towards the Future

By Erin McAndrews

In a world of rapidly advancing technology and innovation, the medical field has experienced many drastic changes and developments throughout its history. From its debut in the medical field in 1985, the medical robot has left many surgeons with mixed emotions – from hopeful and excited to skeptical and cautious.

Surgical robotics are aimed to increase the speed and accuracy of operations, by giving surgeons the tools to increase the precision of their craft. Surgical robotics found its way into the field of spinal surgery in 1992 and has proved immensely useful due to spinal surgery’s precision based nature. Robotics are especially useful in assisting surgeons in caring for patients with spinal abnormalities or poor bone quality. This is evident in the surgical robot, SpineAssist, by Mazor Surgical Technologies. The SpineAssist robot was developed in 2004 and is essentially a bone-mounted robot, which aids surgeons in precise pedicle screw placement (Devito et al., 2010). The mounting feature is paramount because it allows the device to maintain correct positioning despite movement or patient breathing (Devito et al., 2010). This innovation serves as supplementary support, while still giving surgeons autonomy in the operation. In the Devito et al. study of surgical robot accuracy; the SpineAssist robot correctly placed 98% of pedicle screws as determined through fluoroscopy while in surgery (Devito et al., 2010). This rate contrasts the estimated 40% of pedicle screws that are incorrectly placed by surgeons without such aids (Gertzbein & Robbins, 1990).

Similarly, the SPINEBOT v 2 was developed by a research team at Hanyang University in 2010, and showed similar and promising data. The SPINEBOT v 2 was created for transpedicular fixations, with the intent of aiding in tool positioning while the surgeon carried out drilling (Bertelsen et al., 2013). The SPINEBOT v 2 includes surgical planning software for surgeons to strategize screw insertions using patient scans, as well as biplanar continuous fluoroscopy for patient and tool placement detection (Bertelsen et al., 2013). In a 2010 study, the SPINEBOT v 2 had a 92.8% success rate for correctly placed screws throughout varying vertebrae of cadavers (Bertelsen et al., 2013).

Surgical robotics appears promising in aiding surgeons to deliver a higher degree of excellence in their care of patients. Robotics have the potential to support surgeons in refining their craft, or eventually even in redefining the role of a surgeon through autonomous robotics. The prospect of autonomous robotics, though it may evoke thoughts of uncertainty, may make all the difference in reducing operative errors and improving patient outcomes. For example, the VectorBot developed by BrainLab in 2002 was designed as an autonomous articulated arm for placing pedicle screws, as well as other domains of neurosurgery (Gomez, 2011). The VectorBot was intended to act as an assistant to the surgeon, rather than be completely autonomous, while still aiding in precision and accuracy of pedicle screw implantation (Bertelsen et al., 2013). Such technology can greatly impact patient outcomes, while still leaving the surgeon in ultimate control.

Further, tele-operative robotics, or robotics controlled by a surgeon remotely, have also proved successful. For example, the da Vinci robot developed by Intuitive Surgical, has been effective in dural suturing, laminectomies, and other spinal surgical domains in cadaver studies (Bertelsen et al., 2013). Though it was designed and is mostly being used in gynecological and urological operations, the da Vinci has demonstrated success in studies of spinal domains. However, some limitations have been observed in the da Vinci’s drilling capabilities, limiting its realm of spinal surgery potential.

The exact direction and future of surgical robotics is hard to measure; that being said one can safely assume that huge gains in technology, and a wider scope of capabilities of surgical robotics is to come. Current innovators have placed greater emphasis on creating smaller and more economical robots, in order to limit the obstruction of the surgeon’s view of the patient, and increase availability to many hospitals. Furthermore, of the current robotics in development, most innovations trend towards semiautonomous robots (Beasley, 2012), and autonomous technologies in development are still aimed to be an aid to the surgeon rather than completing surgeries independently. Further innovation and creativity in spinal surgical robotics will present positive leaps in surgical outcomes as well as stimulate further medical gains in the capabilities and capacities of surgeons.


References

Beasley, R. (2012). Medical Robots: Current Systems and Research Directions. Journal of Robotics, 2012, 14.

Bertelsen, A., Melo, J., Sánchez, E., & Borro, D. (2013). A review of surgical robots for spinal interventions. International Journal of Medical Robotics and Computer Assisted Surgery, 9(4), 407-422.

Devito, D., Kaplan, L., Dietl, R., Pfeiffer, M., Horne, D., Silberstein, B., . . . Schmieder, K. (2010). Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: Retrospective study. Spine,35(24), 2109-2115.

Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine 1990;15:11–4.

Gomes, P. (2011). Surgical robotics: Reviewing the past, analysing the present, imagining the future. Robotics and Computer Integrated Manufacturing, 27(2), 261-266 .