Information Technology Reference
In-Depth Information
can be corrected by retargeting or in the following iteration but if removed, material
cannot be replaced. This is especially important if a previous surgical repair already
exists in the area to be operated on.
Several research systems have been investigated for spine surgery. Compara-
tively easier procedures such as radiotherapy or percutaneous needle based inter-
ventions account for the majority of recent relevant research. Literature identi
es
over a dozen different robots in development or testing for spine procedures,
however only one was speci
cally designed for spinal surgery [
24
] as therefore
deserves a detailed account here.
Previously developed for percutaneous kidney access, a Georgetown robot [
28
]
integrating RCM/PAKY modules has also been used for spine surgeries. Its reg-
istration software used preoperative CT scans and intra-operative
fluoroscopic
images. Intra-operative guidance permitted the surgeon to then operate the robot
interactively. Other research systems of note include the MIRO [
29
] developed by
the German Aerospace Centre DLR have also investigated for pedicle screw
placement [
16
], the Z-KAT prototype system that preceded the MAKO Rio system
[
30
], the Innomotion device [
31
], and the SpineNav device [
32
].
Spine robotic surgery may also require integrated haptic feedback. While force
sensing and haptic feedback are active areas of research, any sensed forces are
typically displayed with a PHANToM (SensAble Technologies Inc.) a common
haptic device with passive end-effort and only suitable for point force displays.
Research systems such as the MIRO system envision integrating force sensing in
their design, and force sensing [
33
] and display have also been designed for the da
Vinci system, though not currently enabled in the commercial product.
Of particular note here is the parallel mechanism developed by Shoham et al.
[
34
]. This small cylindrical (5
fl
7cm
3
, 200 g) 6DOF Miniature Robot for Surgical
procedures (MARS) robot was designed for spinal pedicle screws placement,
guidance for intramedullary nailing, and other spine applications. The prototype
claimed both ergonomics and safety bene
×
ts from a small footprint while reporting
sub-millimeter (
0.1 mm) accuracy and was later developed into the Mazor
Robotics SpineAssist system.
*
2.2 Current Commercial Systems
Robotic spine procedures are still in early development. As was the case with other
now widely used procedures, early spine surgery procedure development has also
been attempted with the da Vinci surgical systems. We describe some spine pro-
cedure applications of this system below.
Mohr et al. [
35
] attempted spinal surgery using a da Vinci S Surgical Robot in a
non-survival porcine surgery. These procedures were performed by a senior spine
surgeon (though obviously one with very little prior robotic experience), with
prototype and conventional da Vinci instruments developed for other approved
surgical procedures.
