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In-Depth Information
veri
cation is not typically attempted thereby eliminating the major accuracy
advantage of a robotic system.
By Comparison, similar to other navigation tools the SpineAssist [
25
] and the
current Renaissance system (Mazor Robotics) have been extensively used in human
spine surgery. In [
39
] authors note that 646 pedicle screw placements post-opera-
tively assessed by CT imaging resulted in 98.3 % meeting clinical accuracy criteria
with a average deviation of 1.2
1.15 mm on the axial and sagittal
planes respectively. This large retrospective 14-center study performed 3,271 total
spinal implants inserted under SpineAssist guidance with no irreversible nerve
damage reports.
The Renaissance system that followed SpineAssist is also receiving favorable
attention in spine surgery since it may improve accuracy and result in reduced
radiation exposure even for minimally invasive surgery. It has been used in over
20,000 procedures (at more than 34 centers in 2013) with implant placement
accuracy reported to be better than 1.5 mm [
40
]. A proprietary
±
1.49 and 1.1
±
fiducial array, and
rigid attachment to the patient are credited for the accuracy. Registration is per-
formed using two
fluoroscopy images.
Peer-reviewed large volume studies are now beginning to appear in the litera-
ture. For example, the Renaissance and preceding Mazor robotic devices have been
used for the placement of pedicle screws using a preoperatively planned trajectory
[
41
,
42
] for nearly a decade. This technology shows the promise of improving
outcomes in both the accuracy of placement of spinal instrumentation, as well as
reducing the radiation exposure.
With increasing user acceptance, other surgical uses of this robotic guidance are
also appearing on the horizon. Mazor Robotics has received U.S. FDA clearance for
the Renaissance system enables to be used in brain surgery and it has also been used
in several brain surgeries in Europe.
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3 Ongoing Work and Future Prospects
The greatest challenge to using existing general-purpose robotic surgery systems in
constrained environments is their large size that makes it very dif
cult to integrate
them in image-guided surgery clinical work
ow. More compact systems being
designed now, including systems that may attach to the patient bed or operating
room ceiling may alleviate some of the clutter. New instrumentation and techniques
will be developed along with these new systems.
As also noted in other reviews [
1
,
6
,
7
], the small number of surgical robots
currently in use show great potential to improve surgical outcomes especially when
accuracy and minimal invasiveness are needed or access is complicated. In several
portions of the spine, target bone volume is small and the arteries, nerve roots and
spinal cord are all closer to the vertebral bone complex, robotics may be especially
enabling. This is particularly true of robots to be designed or adapted for the
cervical spine.
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