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applications or the orthopedic surgery applications discussed above, typically by
digitizing suf
cient numbers of corresponding anatomical landmarks necessary for
accurately computing a rigid registration.
The remaining sections of this article are limited to a narrow engineering per-
spective on robotic surgery developments speci
cally related to spine surgery. Non-
robotic surgical navigation and registration are addressed separately elsewhere in
this collection.
We also omit simulators for surgical training that may include robotic interfaces,
robots for anatomical testing or rehabilitation, and external therapy or imaging
robotic devices such as those for cone-beam computed tomography.
The reader is referred to clinical reviews for perspectives on human usage, for
example, Bertelsen et al. [
24
] present a clinical perspective of spine related robotics
and Rozer et al. [
25
] focus on the development and use of the commercial spine
robots. For an even broader engineering review of robotic surgery the reader is
referred to [
26
], or similar reviews [
27
,
28
], and for clinical perspectives speci
cally
on spinal robotics developments to reviews such as [
8
,
24
,
25
].
2 Recent Research and Developments
While clinical evaluations of robotic surgery often note [
21
] the need for additional
information overlay as it is dif
cult for a human to interpret multiple sources of
information presented together, it is also non-trivial to establish and maintain any
registration in soft-tissue while it is being manipulated.
Integration of imaging to robotic systems may also add to the radiation exposure
to the surgeon, patient, and staff which can be signi
cant for long cases, revisions,
in the presence of abnormal anatomy or due to additional imaging required for
registration where
fiducials are not visible.
Additional procedure steps also increase total procedure time. Research and
development has therefore, tried to address both clinical work
fl
ow integration as
well as safety issues.
2.1 Research in Systems and Procedures
Conventional procedures still perform the majority of spine surgeries. A retro-
spective review [
8
] of a very large number of spine surgeries performed over
3 years (108,419 procedures between 2004 and 2007) at multiple medical centers
notes that only 13.2 % were performed using a minimally-invasive approaches.
In current commercially available general surgery robotic systems, the surgeon is
guided only by real-time endoscopic video available from the stereo endoscopic
cameras, but the use of registered imaging is integral to robotic spine surgery.
Registration enables mid-course corrections and iterative progress [
12
] since errors
