Robotic orthopaedic surgery

Apollo Medicine 2012 DecemberVolume 9, Number 4; pp. 349e350 Journal Scan

Robotic orthopaedic surgery

Arun Prasad*

Robotic systems in orthopaedic surgery. Lang JE, Mannava S, Floyd AJ, Goddard MS, Smith BP, Mofidi A, Seyler TM,Jinnah RH. J Bone Joint Surg Br. 2011 Oct;93(10):1296e1299.

Source: Wake Forest University School of Medicine, Department of Orthopaedic Surgery, Medical Center Boulevard, Win-ston-Salem, North Carolina 27157, USA.Abstract: Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic tech-nology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use ofrobotic systems has subsequently increased, with promising short-term radiological outcomes when compared with tradi-tional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (orsurgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recentlyby orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improve-ments have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental kneereplacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assistwith increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-termimprovements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assistedorthopaedic surgery has the potential for improving surgical outcomes.

Robot-assisted anterior lumbar interbody fusion (ALIF) using retroperitoneal approach. Minji J. Kim, Yoon Ha, et al.Acta Neurochir (Wien). 2010 April;152(4):675e679.

Abstract:Background: Over the past few years, robot-assisted surgery has become increasingly popular, affecting virtually all surgicalfields. It has been proven to overcome pitfalls of laparoscopic procedures, such as high complication rates and steep learningcurve. We have, therefore, performed experimental anterior lumbar interbody fusion (ALIF) using retroperitoneal approach inswine model to test the feasibility of robot-assisted surgery in spinal surgery.Method: In this report, we describe the setup with the da Vinci� surgical system, operative method, result and discuss technicalaspects and the future of robot-assisted ALIF.Findings: Experimental retroperitoneal dissection using robotic surgical system was successfully performed with great visualcue, minimal retraction and minimal bleeding.Conclusion: Although retroperitoneal approach for spinal fusion has never been attempted with robotic surgical system, wecould demonstrate the possibility with swine model. Further studies and development of appropriate instruments will bring mini-mally invasive spine surgery to a new era.

Senior Consultant Surgeon, Minimal Access Surgery, Gastrointestinal, Robotic, Bariatric & Thoracoscopy, Apollo Hospital, New Delhi 110044,India.*Tel.: þ91 11 29871202, email: surgerytimes@gmail.com

Received: 6.8.2012; Accepted: 7.8.2012; Available online 23.8.2012http://dx.doi.org/10.1016/j.apme.2012.08.004

350 Apollo Medicine 2012 December; Vol. 9, No. 4 Prasad

COMMENTARY

The application of robotic surgery is widespread in orthopaedics surgery, especially in “total hip”. In digital surgeries of THA andTKP, computer navigation systems are used for pre-operative planning. The data obtained is then integrated into a surgicalsystem where robots assist the surgeon during the operation.

Robotic surgery is widely accepted by the orthopaedics community for two reasons. First, the technology is suited for operations onbones. Since bones, unlike soft-tissues, are less prone to deformation when being pressed on, computer navigation and mapping ofbones, which use software based on the rigid-body assumption, are accurate and efficient. Furthermore, robotic surgery increasesthe accuracy of implantation and component placement in THA and TKP. Current surgical techniques often result in inaccurate placingand balancing of hip replacements, knee components, or soft-tissues. With computer navigation system and robot assisted surgery,precision and accuracy is greatly improved; this in turn leads to better long-term outcomes.