Research Topic

Robotics and Spine Surgery

About this Research Topic

Robotics is an exciting and emerging field in surgery, but in its infancy in spine surgery. In general surgery, colorectal surgery, urology and other branches of surgery robotics has developed into a significant part of the surgical armamentarium. In Spine surgery robotics has slowly developed. Despite that, there is increased use of robotics and we are at a stage when robotics are poised to develop into mainstream surgical aid. The editorial plan is as follows:
1. Historical/background perspective on robotics in spine surgery:
- Discuss origins of robotics in surgery; touch on development of the early telepresence devices, cardio/thoracic/abdo set ups, and eventual refinement into the more pertinent systems for spine surgery (i.e. Da Vinci, Mazor – Renaissance/SpineAssist).
- Discuss the major issues within spinal surgery (e.g. pedicle screw inaccuracy and associated complications, high rates of radiation exposure during intraoperative fluoroscopy) and note some of the most prominent studies that have shown beneficial results of robot-assisted surgery.
- Discuss the rapid progression in ergonomics/optimization, imaging and software incorporated with the surgical system.

2. Current practices, beneficial aspects, limitations.
Current practices:
- Pedicle screw insertion (e.g. percutaneous)
- Applied in both PLIF and TLIF approaches with cage implantation and de-compression of the spinal channel by laminotomy or laminectomy.
- Surgical resection of the spinal column/intradural tumors, cases of infection, revision procedures on arthrodesed spines, deformity cases with malformed anatomy.

Beneficial aspects:
- Mitigation of harmful radiation exposure in MIS (beneficial to all parties involved in the surgery); although more costly upfront, you can offset this against the long-term savings of decreased operating time/hospital stay/infection risk. Minimization of any tremor (and collateral damage), maximization of exploiting small working corridors; improvement in manual dexterity, greater control/maneuverability; variable accuracy and precision in comparison to freehand.
- Improved intra-operative visualization and dissection, smaller incisions/surgical fields, reduced blood loss, reduced recovery time, decreased hospital stay.
- Marked decrease in radiation exposure time (34s vs. 77s in robots and conventional approaches respectively); decreased use of postoperative opioid analgesics; reduced adverse events.
- These beneficial outcomes are maximized in robot-assisted percutaneous approaches (vs. open robot-guided vs. freehand-open).
- Provision of better navigation, minimization of malposition ratios during instrumentation, “safer/more secure operation”.

Limitations:
- Steep learning curve; need for greater surgeon experience, cost, training time, operating room dynamics; the literature additionally reflects uncertainty with regards to accuracy and precision in comparison to conventional techniques, some support whilst others refute superiority of robot-assisted surgery vs. conventional. This demonstrates a need for continued research.

3. Future applications and innovations:
- Continued development and integration of the da Vinci, SpineAssist and Renais-sance platforms; reduction in size, increase in quality of software/imaging systems
- Improvement on registration inaccuracies leading to inferior results in comparison to conventional treatment

4. Expansion on current literature; areas of research interest:
- Future research should focus on large, multi-center RCTs with multiple surgeons and a standardized accuracy rating system (e.g. postoperative CT imaging); research is also needed to substantiate that the increased cost will result in benefits that justify the expense.
- Long-term results (e.g. fusion rates) have not been extensively explored comparatively, in terms of robot-assisted vs. conventional free-hand pedicle screw approaches.
- Need to substantiate that the increased cost will result in benefits that justify the expense.
- Long-term results (e.g. fusion rates) have not been extensively explored comparatively, in terms of robot-assisted vs. conventional free-hand pedicle screw approaches.


Keywords: Robotics, Spine, Surgery, Outcomes, technology


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Robotics is an exciting and emerging field in surgery, but in its infancy in spine surgery. In general surgery, colorectal surgery, urology and other branches of surgery robotics has developed into a significant part of the surgical armamentarium. In Spine surgery robotics has slowly developed. Despite that, there is increased use of robotics and we are at a stage when robotics are poised to develop into mainstream surgical aid. The editorial plan is as follows:
1. Historical/background perspective on robotics in spine surgery:
- Discuss origins of robotics in surgery; touch on development of the early telepresence devices, cardio/thoracic/abdo set ups, and eventual refinement into the more pertinent systems for spine surgery (i.e. Da Vinci, Mazor – Renaissance/SpineAssist).
- Discuss the major issues within spinal surgery (e.g. pedicle screw inaccuracy and associated complications, high rates of radiation exposure during intraoperative fluoroscopy) and note some of the most prominent studies that have shown beneficial results of robot-assisted surgery.
- Discuss the rapid progression in ergonomics/optimization, imaging and software incorporated with the surgical system.

2. Current practices, beneficial aspects, limitations.
Current practices:
- Pedicle screw insertion (e.g. percutaneous)
- Applied in both PLIF and TLIF approaches with cage implantation and de-compression of the spinal channel by laminotomy or laminectomy.
- Surgical resection of the spinal column/intradural tumors, cases of infection, revision procedures on arthrodesed spines, deformity cases with malformed anatomy.

Beneficial aspects:
- Mitigation of harmful radiation exposure in MIS (beneficial to all parties involved in the surgery); although more costly upfront, you can offset this against the long-term savings of decreased operating time/hospital stay/infection risk. Minimization of any tremor (and collateral damage), maximization of exploiting small working corridors; improvement in manual dexterity, greater control/maneuverability; variable accuracy and precision in comparison to freehand.
- Improved intra-operative visualization and dissection, smaller incisions/surgical fields, reduced blood loss, reduced recovery time, decreased hospital stay.
- Marked decrease in radiation exposure time (34s vs. 77s in robots and conventional approaches respectively); decreased use of postoperative opioid analgesics; reduced adverse events.
- These beneficial outcomes are maximized in robot-assisted percutaneous approaches (vs. open robot-guided vs. freehand-open).
- Provision of better navigation, minimization of malposition ratios during instrumentation, “safer/more secure operation”.

Limitations:
- Steep learning curve; need for greater surgeon experience, cost, training time, operating room dynamics; the literature additionally reflects uncertainty with regards to accuracy and precision in comparison to conventional techniques, some support whilst others refute superiority of robot-assisted surgery vs. conventional. This demonstrates a need for continued research.

3. Future applications and innovations:
- Continued development and integration of the da Vinci, SpineAssist and Renais-sance platforms; reduction in size, increase in quality of software/imaging systems
- Improvement on registration inaccuracies leading to inferior results in comparison to conventional treatment

4. Expansion on current literature; areas of research interest:
- Future research should focus on large, multi-center RCTs with multiple surgeons and a standardized accuracy rating system (e.g. postoperative CT imaging); research is also needed to substantiate that the increased cost will result in benefits that justify the expense.
- Long-term results (e.g. fusion rates) have not been extensively explored comparatively, in terms of robot-assisted vs. conventional free-hand pedicle screw approaches.
- Need to substantiate that the increased cost will result in benefits that justify the expense.
- Long-term results (e.g. fusion rates) have not been extensively explored comparatively, in terms of robot-assisted vs. conventional free-hand pedicle screw approaches.


Keywords: Robotics, Spine, Surgery, Outcomes, technology


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

31 March 2018 Abstract
30 September 2018 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

31 March 2018 Abstract
30 September 2018 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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