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cult to measure without post-operative assessment.
Therefore, in addition to improving instrumentation (e.g. new laparoscopic dis-
traction devices are in development), future systems will need to provide a lot more
data, and still somehow reduce overall operating time to be comparable to con-
ventional open or minimally-invasive surgery.
The promise of natural ori
Accuracy/ef
cacy is dif
ce transluminal surgery (NOTES) is exciting to both
general and spine surgeons alike. However, the same key issues need to be
addressed prior to the incorporation of NOTES into spine surgery practice. NOTES
instrumentation has only been used for relatively simple surgeries (e.g. appendec-
tomies and cholecystectomies).
Current research and development is mainly focused on evaluating the ef
cacy
of the robotic devices that have been relatively recently introduced in practice.
Important concerns such as optimization of device user interfaces, training for
robotic devices, learning curves for these devices and corresponding training cur-
ricula are beginning to emerge. As with robotic laparoscopic surgery, these
developments precede the development of standard testing and accreditation
methods likely to be needed in the future.
Procedure development work identi
es [
35
,
36
] that cost, complexity, and lack
of spine speci
c instrumentation offset many advantages of a robotic surgery
platform. It is likely that the progress in these areas will continue to be made only in
the context of systems and applications that are already deployed.
We envision that as next generation systems become available to spine surgeons
and experience with these systems increases, the pace of development of robotic
surgery systems should also hasten and lead to complete active robotic systems
designed speci
cally for image-guided spine surgeries.
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