Accuracy of robotic-assisted pedicle screw placement comparing junior surgeons with expert surgeons: Can junior surgeons place pedicle screws as accurately as expert surgeons?

Abstract

Background

The purpose of this study was to verify whether a spine robotic system was useful for junior surgeons.

Methods

Twenty-seven patients underwent posterior spinal fusion with open surgery using a spine robotic system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland) from April to August 2021. Pedicle screw insertions were performed by five surgeons. The surgeon and insertion time were recorded for each pedicle screw. Two surgeons who are board-certified spine surgeons by the Japanese Society for Spine Surgery and Related Research (JSSR) were defined as the expert surgeon group. Three surgeons who were training to acquire qualifications as JSSR board certified spine surgeons were defined as the junior surgeon group. In postoperative CT images, the deviation of 255 pedicle screws was evaluated using the Gertzbein-Robbins (GR) grades.

Results

In the expert surgeon group, the GR grades were Grade A for 79 screws (90.8%), Grade B for 6 (6.9%), Grade C for 2 (2.3%), and 0 (0%) for Grades D and E. I In the junior surgeon group, the GR grades were Grade A for 162 screws (96.4%), Grade B for 6 (3.6%), and 0 (0%) for Grades C, D, and E. There was no significant difference in the deviation rate between surgeon groups (p = 0.08). The mean insertion times were 174.5 ± 83.0 s in the expert surgeon group and 191.0 ± 111.0 s in the junior surgeon group. There was no significant difference in the insertion time between surgeon groups (p = 0.22).

Conclusions

There were no significant differences in the deviation rate and the insertion time of robotic-assisted pedicle screw placement between expert surgeons and junior surgeons who were training to acquire qualifications as JSSR board certified spine surgeons. Robotic-assisted pedicle screw placement can be effectively employed by junior surgeons.

Introduction

The first surgical robotic system “PUMA” was developed in 1978, and it was reported that the first robotic surgery on humans was performed in 1985. This was a neurosurgery biopsy operation [1,2]. Later, this system was applied to urological surgery. “Da Vinci” is a well-known surgical robotic system that assists laparoscopic surgery with robotic arms. The minimal invasiveness is equivalent to conventional laparoscopic surgery. However, special training is required to operate the surgical robotic system and a learning curve to develop surgical expertise is essential [3,4].

A spine robotic system is a technology that combines a robotic arm with a spine surgical navigation system. The first spine robotic system was SpineAssist (Mazor Robotics, Caesarea, Israel), which was developed in Israel in the early 2000s [5,6] and was approved by the U.S. Food and Drug Administration in 2004 [7,8]. Improved models such as Renaissance and X were developed in 2011 and 2016, respectively. In 2018, Medtronic developed robotic spine surgery as the Mazor X Stealth Edition. In Japan, the three spine robotic systems, Mazor X Stealth Edition (Medtronic Inc., Dublin, Ireland), ExcelsiusGPS (Globus Medical, Pennsylvania, USA), and Cirq (BrainLab, Munich, Germany) have been available since 2021.

The spine robotic systems are based on a different concept from the Da Vinci surgical robotic system. In robotic-assisted pedicle screw placement, if the planning of pedicle screw placement is accurate, even junior surgeons may be able to place the pedicle screws properly. The purpose of this study was to verify whether a spine robotic system was useful for junior surgeons. We hypothesized that junior surgeons could place pedicle screws as accurately as expert surgeons.