These images are loaded into a computerised 3D planning system so that in the operating room, surgeons do the physical surgery while the system guides his or her instruments based on pre-operative planning of spinal implant placement.
By HS Chhabra
Recent advancements in spine surgery have come in the form of robotics, a specialised approach to a complex procedure that allows planning a surgery and facilitates highly accurate and predictable execution of the plan. Robotics is particularly helpful in inserting implants in the spine; for a spine surgeon, robotics is a boon, and has marked the beginning of a new era in spine surgery.
Planning is the foundation of surgical robotics; the ability to plan a surgery in an advanced 3D visual environment allows a surgeon to factor any unique anatomy or challenges associated with the patient much ahead of the surgery. The technology allows surgeons to use images from a computerised tomography scan (CT scan) taken before surgery to create a blueprint for each case. These images are loaded into a computerised 3D planning system so that in the operating room, surgeons do the physical surgery while the system guides his or her instruments based on pre-operative planning of spinal implant placement. During the surgery, the robot is placed near the patient either by attaching it to the bed or directly anchoring it to the spine of the patient.
The latest generation robotics also has an infra-red camera that continuously tracks and navigates the movement of instruments and implants in relation to the patient anatomy and surgical plans.
Some of the benefits of using robotic assistance for spine surgery include:
Smaller incisions and better surgical accuracy: The robotic guidance system is an extension of the surgeon’s skills, and supports him or her throughout the procedure. It allows the surgeon to place pedicle screws with the help of patient-specific plan and a suite of tools. Robotics technology is designed to help predictabilityand precision so that the surgeon can work making smaller incisions but deliver better accuracy.
Less risk for surgical complications: Robotics systems come with navigation technology that helps visualise the progress of the surgery in real time. Also known as stealth navigation technology for specific systems, it gives the surgeon the confidence to address any challenge during the surgery.
Less radiation exposure: Robotic surgery can reduce radiation exposure both for patients and the surgeon. Studies have revealed that there is 74% less radiation as compared to fluoroscopy and 50% less radiation as compared to navigation.
Shorter hospital stay: Surgery with the help of robotics ensures the patients undergo less physical strain. As a result, they recuperate faster. It also reduces the chances of revision surgeries.
Having assessed the wide range of benefits of adopting to robotics assistance, the Indian Spinal Injuries Centre (ISIC), New Delhi, has very recently acquired a system to ensure better and quicker service to the patients. This robotic system combines advanced software, robotic technology, navigation, and instrumentation and has deep Artificial Intelligence (AI) and sophisticated 3D analytics component as well.
We expect the next wave of innovation to come with greater element of AI incorporated into robotics. This will further automate many of the decisions that the surgeon makes before and during the surgery. Besides AI, researchers around the world are also working on improved handling of soft tissues. This will happen as the system develops the ability to recognise soft tissues from MRI. Both AI and soft-tissue handling are expected to be the biggest driver of innovation in spine robotics. The day is not far when spine surgery could be performed in an out-patient setting with robotics.
The writer is medical director & chief of spine, Indian Spinal Injuries Centre (ISIC)