The concept of minimally invasive surgery (MIS) has gained increasing popularity in the last several decades among many surgical specialties. Spinal surgery has also trended for years towards smaller incisions and biologic materials that minimise surgical duration and approach-related morbidity. One of the greatest innovations of MIS is the introduction of robotics in theater.
The Mazor Robotics system allows the surgeon to use the images from a CT scan that is taken before surgery to create a blueprint for each surgical case. The surgeon plans the surgical procedure with a high degree of precision before ever entering the operating room and in the operating room the robot-guidance system will help to guide the surgeon’s instruments based on this highly accurate pre-operative planning.
During the surgery, the robot is placed near the patient either by attaching it to the bed or directly anchoring it to the patient's spine. The robot is approximately the size of a beverage can with a small arm attached (Fig 1.) The robot has the ability to bend and rotate in order to place its arm on the spine in a very specific location and trajectory. This ultra-precise guidance improves the surgeon’s ability to safely place implants, particularly when working through very small incisions which is the case during minimally invasive surgery, but also when dealing with complex anatomy which is commonly the case in older patients.
Figure 1. Mazor Robot
Many spinal disorders can be treated using minimally invasively techniques including degenerative disc disease, herniated disc, degenerative or idiopathic scoliosis and spinal stenosis. In a recent meta-analysis, Joseph et al.1 did not report significant differences in clinical outcomes between open and MIS procedures but this meta-analysis supports decreased operating time, reduced blood loss, decreased length of hospital stay, and decreased complication or reoperation rates in MIS. In addition, reduced perioperative analgesia has been reported in MIS. All these advantages are particularly important managing older or more fragile patients.2
Robot-guided spine surgery is a promising new technology that has many advantages and may allow surgeons to perform less invasive surgical procedures with smaller incisions, less bleeding and shorter hospital stays. Robot-guidance also can increase the accuracy and safety of surgical procedures and allow these procedures to be performed with less intra-operative radiation exposure to patients and health care providers. It is particularly useful in young patients to reduce recovery time and in older patients to reduce and decrease the physiological impact of surgery and to improve the complication profile.
Dr Martin Scholsem, MD FRACS
Dr Martin Scholsem graduated from the University of Liege, Belgium with First Class Honours in Bachelor of Medicine and Bachelor of Surgery in 2001. He completed his neurosurgery training in 2007 and a fellowship at Royal Melbourne Hospital and St George Hospital in 2009. He is currently working as a VMO at St George Public and Private Hospital and at Hurstville Private Hospital.