Jan. 23, 2021
Mayo Clinic has performed more than 200 robot-assisted spinal surgeries, with positive early outcomes and declining procedural times.
"Robotics has given us options to treat patients more safely and effectively," says Mohamad Bydon, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota.
Among 402 screws placed in 77 patients who had robot-assisted spinal surgery at Mayo Clinic, none required postoperative revisions, according to a study to be published in Mayo Clinic Proceedings. Two of the 402 screws required revision intraoperatively, and no complications related to screw placement were encountered in any of the patients studied.
"The robotic platform significantly enhances the accuracy of screw placement. It removes any human error that might be associated with fluoroscopically guided screw placement or even with stereotactic navigation," says Selby G. Chen, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida.
With the accrual of surgical experience, operative time declined significantly during the study period of Sept. 4, 2018, to Oct. 16, 2019. During that period the number of procedures performed per week increased.
"Although there is a learning curve with this technology, it is surmountable," says Matthew T. Neal, M.D., a neurosurgeon at Mayo Clinic in Phoenix/Scottsdale, Arizona. "It is advantageous to develop comfort and familiarity with the technology at an early stage because we anticipate the robot will have increasing capabilities moving forward."
The majority of robot-assisted spinal surgeries performed at Mayo Clinic are lumbar fusions and thoracolumbar fusions. Patients have preoperative and sometimes intraoperative CT imaging, which navigational software uses to help create a surgical plan. During surgery the software guides a robotic arm into position to ensure that the preoperative plan is accurately translated to trajectory guidance in the surgical field.
"As a result of the minimally invasive approach, patients have less pain and a lower need for pain medication," Dr. Bydon says.
The procedure can be performed with the patient awake or under anesthesia. Among patients in the Mayo Clinic study, the median length of hospitalization following the minimally invasive surgery was two days.
As an early adopter of robot-assisted technology, Mayo Clinic is able to look ahead to future applications. "We hope that as the technology advances, we will be able to apply it to the cervical spine as well as spinal decompression, disk preparation, the insertion of interbody cages and deformity correction," Dr. Chen says.
Robot-assisted spinal surgery exemplifies Mayo Clinic's patient-centered approach. "The accuracy and efficiency of the robot is part of our strategy to help reduce patients' pain and enhance their recovery after spinal surgery, which are of the utmost importance to us," Dr. Neal says.
For more information
Bydon M, et al. Initiation of a robotic program in spinal surgery: Experience at a three-site medical center. Mayo Clinic Proceedings. In press.