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Robot-assisted percutaneous pedicle screw fixation for thoracolumbar vertebral fracture (Surgeon: Prof. TIAN Wei)

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Introduction

The application of various surgical robot systems is becoming wider in the last few years. Beijing Jishuitan hospital designed a brand new orthopedics surgery robot recently. The new robot workstation combines the robot technique with the navigation technique to try to achieve a better accuracy. We did the first two upper cervical robot-assisted spine surgeries in the world. We also did the first robot-assisted CAMISS (computer-assisted minimally invasive spine surgery) around the world.

Methods

After general anesthesia and patient positioning, a set of intra-operative 3D images was obtained by ARCADIS Orbic 3D (Siemens Medical Solution, Erlangen, German) and simultaneously transferred to the new robot-assisted surgical system (TiRobot, TINAVI Medical Technologies Col, Ltd.) that designed by our hospital (Figure 1&2).

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After planning of trajectories in the host machine by surgeons, the guide holder that mounted on the robot arm moved spontaneously to the exact entry point according to the plan. Through the holder, surgeon drilled the guide pins and then placed the screws. Postoperative CT images were taken and merged with the surgical plan, the deviation of planned screw position and actual screw position was measured. Operating time, blood loss and postoperative neurovascular complications were also recorded.

Case 1

As the first robot-assisted CAMISS around the world, before this human surgery, we had tried percutaneous pedicle screw fixation on 5 mini-pigs and got satisfied results.

A 28-year-old male presented with back pain after a fall injury. He had no neurologic deficit on neurological examination. The lumbar CT images demonstrated that there was a burst fracture of L1 vertebrae body (Figure 3).

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he surgery was taken on August 6th, 2015. After general anesthesia and patient positioning (prone), we placed the patient tracker on the spinous process of T10. 3D C-arm scanning and robotic planning was carried out using TiRobot system. Virtual drill trajectories were planned on the 3-dimensional software (Figure 4).

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Six transverse skin incision was made under the robotic guidance. Expose bluntly to the starting points. Through the sleeve of the robotic arm, we drilled 6 guidewires into the pedicle screws of T12, L1 & L2, then inserted two screws of 5mm in diameter, 35mm in length into L1, four screws of 6mm in diameter, 50mm in length into T12 and L2. We found the placement of the screws and rods were satisfied due to the intraoperative 3D C-arm fluoroscopy scan. The surgery took 3 hours. The blood loss was 50 ml.

There was no intraoperative complication. The patient had maintained full extremity strength and sensation. By postoperative CT images (1 day) (Figure 5), there was no perforation and loose of the screw.

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