How Much OR Time Do Robots Save, Really?

A new study by Hospital for Special Surgery (HSS) has not only evaluated accuracy of robotic- and navigation-assisted technology in adult spine surgery screw placemennt, but also what, if any, time savings the robotic assist devices provided.

Darren Lebl, M.D., M.B.A., a spine surgeon at HSS and study co-author explained the rationale to OTW:“The impetus for this research is the need to improve outcomes for patients with spinal disorders. The thing that I am most passionate about is finding new ways to relieve pain and improve patient quality of life in the absolute best way possible.”

“We all know people who have ongoing issues with the neck or lower back that never seem to get better. Years ago, there were not a lot of good options for surgically fixing these issues. Using technology in the operating room with precise anatomic localization, we have the ability to treat issues with the neck or lower back with very targeted minimally invasive procedures.”

The study, “Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes,” was published in The Journal of Spine Surgery in June 2021.

The study enrolled 65 adult patients with lumbar degenerative pathology who had been treated with robotic-navigated posterior spinal fusion from June 2019 to July 2020. The surgeons in the study performed a total of 364 instrumented pedicle screw implants using the Medtronic Mazor X Stealth Edition system. All procedures were performed by the same orthopedic surgeon, who had more than 10 years of experience and had placed thousands of screws with previous techniques.

Robotic Speed vs. FreeHand Speed? 6 Second on Average…But

“The mean time per screw placement was 3.6 minutes (216 seconds) robotically versus 3.7 (222 seconds) minutes freehand, with a significant decrease in time between the first 10 and last 10 cases: 5.5 minutes versus 2.3 minutes,” wrote the authors. “Setting up the robotic navigation system in the OR showed a decrease in time between the first 10 and last 10 cases: 9 minutes versus 6 minutes.”

Describing progress made to OTW, Dr. Lebl stated, “The process of robotic-assisted surgery using targeted minimally invasive navigation involves effectively creating a 3-dimensional image or map of the spine that is used in the operating room.”

“During the procedure, the surgeon’s instruments and any spinal implants are visualized on that three-dimensional map of the spine in real time for highly accurate and precise positioning. Historically, in order to visualize the spine 3-dimensionally it was necessary to expose the spinal anatomy which often involved stripping and cutting of muscle and tissue. With robotic-assisted technology, the surgical team can in essence see the spine’s position in space and anatomy prior to making any incision. This allows smaller surgical incisions, ultra-precise surgery, and associated quicker recovery times.”

When OTW asked what further study might be done, Dr. Lebl said, “The pace of technological advancement in this area has accelerated greatly in recent years. In the coming years, my team will be continuously evaluating new technologies to determine which are the best to help maximize patient performance and quality of life. This will include microendoscopic procedures, robotic-assisted procedures, surgical navigation, and the introduction of augmented reality in the operating room.”

“It is an exciting time in spinal surgery. Developments in robotics and advanced intraoperative navigation and imaging are allowing surgeons to achieve better outcomes with smaller surgical incisions than ever before.”