Advancements and Impacts of Robotic Surgery in Orthopaedics

Role of Robotic Surgery in Spinal Trauma

The use of robotic surgery in orthopaedics has been one of the recent advancements in the clinical practice, and it has showed good short-term results1. It has the advantage that it helps in the translation of pre-operative planning to intra-operative steps, thereby increasing the precision and accuracy with enhanced execution of surgery2. Lack of direct visibility of the anatomical structures in spine surgery makes the use of robotic surgery in this field all the more promising. Such use helps in reducing implant misplacements, thereby avoiding neurological complications in spine surgeries where implants are inserted3. It also helps in decreasing the radiation exposure which usually takes place to

Pre-operative planning including CT scan in which the individual vertebrae are marked and segmented is very crucial for surgeries using the above systems as the patient gets registered by matching the intra-operative radiological pictures with those on the previously done CT scan. The tactile sensations of the surgeon still have important part during screw placements as the robotic system just guides the process and does not put the screws itself. It provides a trajectory for the ideal pathway of screw insertion using which the surgeon can do his/ her work with precision. It is mainly utilised in pedicle screw placement in thoracic, lumbar and sacral spine although it can also be used for kyphoplasty and other procedures which follow a single trajectory such as spinal needle biopsies18. The newer advancements in the Renaissance system enable 3-D reconstruction of images taken with an image intensifier in the operation theatre19. This system was the first robot system to be USFDA approved for spinal

In contrast to the SpineAssist/ Renaissance system where the surgeon actually does the operative work using his/ her own touch sensations, this system consists of a surgical console where the surgeon is seated at a distance from the patient looking at a screen. In this system, the robot has various arms which are used to hold endoscope and various surgical equipments. The surgeon controls movements of the different arms in real time using two handles. It has various advantages as compared to the human hands like allowing 7º of liberty in movements. Moreover, it has inbuilt system to reduce tremors by downscaling movements by 1:1, 1:3 or