שנה שפה:

When Giants Talk; Robotic Dialect during Spine Surgery



Saadit Sarah Houri1, Meir Liebergall1, Amal Khoury1, Avraham Soroka2, Leon Kaplan1, Josh E. Schroeder1
1 Orthopedic Department, Hadassah Medical Center, Jerusalem, Israel
2 Radiology Department, Hadassah Medical Center, Jerusalem, Israel

Introduction: Robotic assisted spine surgery has been used for over a decade using navigation assistance robot. These system allow intraoperative drilling of trajectories based on preoperative CT scans merged with intraoperative fluoroscopy images. However in cases of vertebrae fractures due to fragment motion, the level of accuracy may decrease. Imaging robot allows high level live intraoperative imaging. The dialect between the two robots allows an increased level of patient safety.

Methods: Patients were operated in a hybrid operating room. After patient positioning, a navigation assistance robotic star marker was placed on the patient`s spine and a 3D scan was performed. The images were transformed to the navigation assistance robotic station and screw trajectories were planned. In order for this dialect to conform, several optimizations of both robots were needed. Data output had to be changed, and settings on the imaging robot scanner needed to be modified for complying with the navigation assistance robot requirements. Trajectories were executed and verified with another 3D scan. Hardware placement was performed in the routine manner.

Results: Six surgeries were performed in five patients in 2017; four patients with traumatic spinal fractures (flexion distraction injury, and three burst fractures) and one patient with multi-level thoracolumbar compression fractures due to severe osteoporosis. Average age was 43 (range 23-67); 2 were male and 3 female. Average radiation time was 52.8 seconds for the whole case (range 24-114 seconds). A total of 43 trajectories were performed all were accurate and the vertebral positioning were improved after the operations. Levels operated were between T4 and S1. There were no procedure related complications.

Conclusion: The combination of surgical robots increases patient safety and increases surgeon and patient confidence in large, complex and percutaneous procedures. We believe this merging of technologies is a small step forward benefiting with our patients.

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Saadit Sarah Houri