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The goal of these surgical procedures was to mimic conventional technique for
dissection of 3 spinal lumbar levels as well as laminotomy, laminectomy, disc
incisions, and dural suturing, As it was the case with most early procedures
developed, video recordings were made and procedure times, ergonomic assess-
ments, and surgical mistakes or dif
culties noted for possible improvements in
surgical technique.
Another report by Yang et al. [
36
] describes lumbar fusion using da Vinci
Surgical System. Positioning the patient in a steep Trendelenburg position, this six-
hour procedure was only possible while accommodating robotic arm complications
related to unresponsive instruments as well as collisions of instrument holding
robots outside the body due to suboptimal arm con
gurations necessary for the
procedure. While con
guration and software issues did not result in any signi
cant
nerve or vessel injury, the report con
rms the challenges of adopting a robot not
designed for spine surgery.
Yang et al. [
37
] also performed a da Vinci odontoidectomy on a cadaver with
fewer ergonomics issues and reduced soft tissue damage, and note bene
ts from
improved ergonomics and access due to increased freedom of movement at the
wrist of the da Vinci instruments.
Further along in the procedure development curve, [
38
,
39
] describe human
lumbar fusion at L5
S1 using new Gelpoint access ports and new robotic instru-
ments performed by an experienced surgeon. While reduced, the challenge of
maintaining pneumoperitoneum during the discectomy, especially during place-
ment of the interbody cage remains signi
-
cant even with smaller incisions as noted
by Beutler et al. [
38
].
Some of the challenges in this report may also relate to inexperienced surgeons
who also had no prior robotic surgery experience. Surgeons in head/neck surgery
and skull base procedures using transperitoneal, transthoracic, and transoral
approaches [
22
] have adapted to some of these limitations with greater success.
However, the overall assessment remains that these developments are forward
looking research aimed at creating a knowledge base for robotic systems designed
speci
cally for spine surgery.
Mohr et al. [
35
] also admit that many obvious challenges remain before spine
surgery using such a large system could be considered a realistic application.
A major challenge is arranging
fluoroscopic imaging in an operating room along
with large footprint robot and accommodating the additional personnel. This may
require pre-operative imaging prior to the robot being moved in place, and some
times prevent real image-guided surgery.
Literature also questions the large investment needed (up to $1.7 million) in
system costs and annual maintenance, if expanded speci
fl
cally for spine surgery, in
the absence of an established or approved spine procedures, or trained surgeons.
Instead of justifying such expenses for an ergonomic aid, it is hoped that hos-
pitals with under-utilized da Vinci surgical systems might bene
t from the addition
of other specialties performing procedures and helping to amortize overall system
and maintenance costs.
In current development approaches,
intra-operative
