机器人导航和脊柱手术的未来

2019年6月，在Daniel Hedequist, MD,Spine Divisionat Boston Children’s Hospital became one of the first pediatric orthopedic centers in the country to use the Mazor X Stealth Edition robotic guidance system in its surgical suite. The system, which received FDA approval in March 2019, combines preoperative planning software, a robotic arm, and stealth navigation to assist surgeons in the placement of surgical hardware as they perform spinal fusion surgery.

在2019年6月至2020年11月之间，我们的脊柱部门外科医生使用Mazor X Stealth Edition机器人指导系统进行了75多次脊柱手术。如您所怀疑的那样，引入系统需要进行前期的时间承诺。由于外科医生和团队获得了机器人导航的经验，因此在早期阶段花了更长的时间。该系统最初仅用于涉及简单的解剖结构和螺钉放置的直接案例。每次手术后，临床医生开会进行汇报，以审查程序和可能的改进。如今，脊柱部门的外科团队使用机器人指导系统广泛地纠正idiopathic scoliosis,neuromuscular scoliosis, congenital spine deformities, and脊椎前移。

“机器人手术”一词表明外科医生的工作是由机器进行的。此假设不适用于Mazor X机器人指导系统。波士顿儿童的脊柱外科医生更喜欢“共同手术”一词，以表彰外科医生在整个手术过程中的非常积极的作用。例如，外科医生必须进行持续的安全检查，以确认机器人臂建议的每种轨迹的准确性。在极少数情况下，机器人臂可能未对准，外科医生必须在进行前进或冒灾难性的患者受伤。根据Hedequist的说法，波士顿儿童外科医生接受了脊柱畸形手术的经验以及Mazor X Stealth技术的准确性，因此在所有情况下都可以安全地应用这种创新技术。

机器人ic aiming arm with cannula inserted, confirming starting position with the use of navigation instrumentation.

Potential benefits

一旦该系统得到充分实施并接受了手术团队的培训，机器人指导系统将对患者和提供者都有潜在的好处。该系统可能会提高螺丝置的精度，并导致修订手术的减少。脊柱融合手术可以在更少的时间内完成，从而减少患者在麻醉和暴露于荧光镜检查下的时间。通过减少手术室中螺钉和托盘的处理和再处理（OR），机器人指导也可以降低感染的风险。但是，要确定这些潜在的改进是否会发挥作用，这将需要进一步的研究。

Advancing the navigated drill through the robotic aiming arm with cannula

未来的创新

The Boston Children’s Spine Division chose to embark on this project because we believe robotic guidance will be a driving force in the rapidly expanding field of surgical technologies. Demands for patient safety, quality of care, cost-effectiveness, as well as payor regulations will be primary drivers in the continued evolution of robotic technologies and their widespread adoption in the OR.

为了帮助确保机器人指导技术带来其潜在的好处，脊柱部门正在与其他四个儿科中心组成一个研究小组，这些小儿中心也是Mazor X Stealth Edition System的早期采用者。我们将共同汇总和分析手术数据，以确定机器人导航对手术效率，患者安全性，OR和荧光镜检查的影响。将来，我们还可以作为外科医生探访中心，其他提供商可以在这里看到使用的系统。

通过机器人瞄准臂进行导航钻的过程的其他视图

Key takeaways

Any spine center considering a robotic guidance system should keep the following points in mind:

• 机器人技术将对未来的手术技术产生深远而持久的影响。
• Any surgeon using the robotic guidance system should have extensive experience and knowledge of spinal fusion surgery to assure patient safety.
• The initial learning curve is steep and requires an up-front commitment of time as surgical teams become familiar with the system.
• 外科团队应计划在每种情况下进行汇报，以审查未来的程序和可能提高效率的效率。
• 机器人导航有可能提高准确性和效率并降低成本，但是，在此早期阶段，这些收益尚未进行测试。

Screen shot of intraoperative planning software, setting the starting point, trajectory, and size of pedicle screws

机器人ic guidance: Technology components

The Mazor X Stealth robotic guidance system is an expansion of the O-arm intraoperative CT scanning technology and surgical navigation that has been in use in the Spine Division since 2015. The robotic guidance system introduces the following components to spinal surgeries:

Preoperative planning software——使用解剖图片,软件帮助杂志ical teams determine appropriate screw size for the patient before the surgery, eliminating the need for back-up implant trays in the surgical suite. Surgical teams can also use the software to plan ahead for surgeries on difficult anatomies.

机器人手臂— After registering a patient’s anatomy and confirming anatomical landmarks, the robotic arm guides the trajectory of pedicle screw placement.

隐形导航- 提供对患者解剖结构和螺丝轨迹的实时确认，使外科医生能够验证每种植入物的精确放置。

Additional pre- or intra-operative planning view option allowing visualization of the computed topography (CT) anatomy and planned pedicle screw trajectory

X-rays of spine pre- and post-surgery with Mazor X

Publications

Gonzalez D，Ghessese S，Cook D，Hedequist D.Initial intraoperative experience with robotic-assisted pedicle screw placement with stealth navigation in pediatric spine deformity: an evaluation of the first 40 cases。J Robot Surg. 2020 Oct 22. doi: 10.1007/s11701-020-01159-3. Online ahead of print.

Hedequist DJ, Erikson MA, Larson AN.小儿脊柱手术中的导航和机器人技术。jposna。2020年5月；第2卷第1卷。

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