World Neurosurgery

Robot-assisted pedicle screw placement is safe and accurate in both experienced and two supervised, in-training surgeons

Publication date: Available online 25 June 2019Source: World NeurosurgeryAuthor(s): Mehdi I. Siddiqui, David J. Wallace, Luis M. Salazar, Arnold B. VardimanAbstractObjectivesTo describe the learning curve of pedicle screw placement using Robot-Assisted Spine Surgery (RASS) of an experienced neurosurgeon and two supervised neurosurgical fellows.MethodsThe first 120 cases of RASS at our institution were assessed. Patient variables included age, body mass index (BMI), and indication for surgery. Intra-operative...

World Neurosurgery

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Robot-assisted pedicle screw placement is safe and accurate in both experienced and two supervised, in-training surgeons 14h
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Publication date: Available online 25 June 2019

Source: World Neurosurgery

Author(s): Mehdi I. Siddiqui, David J. Wallace, Luis M. Salazar, Arnold B. Vardiman

Abstract
Objectives
To describe the learning curve of pedicle screw placement using Robot-Assisted Spine Surgery (RASS) of an experienced neurosurgeon and two supervised neurosurgical fellows.

Methods
The first 120 cases of RASS at our institution were assessed. Patient variables included age, body mass index (BMI), and indication for surgery. Intra-operative variables included the vertebral level of screw placement, number of screws placed by each operator, intraoperative blood loss, and operative time. Post-operative variables included Length of stay (LOS), discharge disposition, 30-day readmissions, wound complications, and hardware revisions. Screw accuracy was determined with image overlay analysis comparing planned screw trajectory on the navigation software to the intra-operative CT scan with final screw placement. 2-dimensional accuracy was determined for the tip of the screw, tail of the screw, and angle the screw was placed. The supervising physician and first fellow began utilizing the robot concurrently upon its arrival, while the second fellow began using the robot after the system had been in place for seven months.

Results
Both experienced surgeon and first fellow displayed a learning curve and achieved statistically significant improvement of accuracy after 30 screws. The second fellow had significantly better accuracy than the experienced surgeon in his first 30 screws. There were no complications from hardware placement in either group. There were no returns to the operating room for hardware issues.

Conclusions
RASS is a safe, accurate method of pedicle screw instrumentation. Our data shows similar learning adaptation rates for the first fellow and the experienced surgeon. Techniques learned by attending were immediately transferable to a new learner, who was able to achieve a faster learning curve than both first fellow and experienced surgeon.