“Robot-assisted spine surgery is the most advanced technology available today and is here to stay.”
Robot-assisted spine surgery: the new standard
Summary
J ust a few years ago it was seen as a futuristic technology, but today it is rapidly becoming the new standard: the best choice for an increasing number of cases and spinal conditions with the highest success rate and with a wide range of benefits for the patient. Robot-assisted spine surgery is the most advanced technology available today and is here to stay. But remember: Despite the growing debate surrounding Artificial Intelligence and autonomous robots, robot-assisted spine surgery and all robot applications in the medical field in general do not fall under this category as they still require human input. As the term itself highlights, robot-assisted surgery is performed by surgeons with the assistance of robots, which remain highly advanced, but passive, tools in the hands of the surgeon, who makes assessments and takes the appropriate decisions to plan and perform the surgery. That is why the surgeon’s knowledge and experience – including in the use of the equipment – remain crucial and fundamental.
How Robot-Assisted Spine Surgery Works
To understand the great innovation brought about by the use of robots, let’s briefly examine how traditional open spine surgery is performed and has been performed so far. In traditional procedures, a surgeon needs to make large incisions to perform the operation. In order to ensure optimal visibility for the surgeon, the muscles must be detached and cut to expose the surgical area. Additionally, the physician should constantly obtain radiological images, such as in procedures using CT-assisted spinal navigation, to precisely position screws and cages, which unfortunately results in exposing the patient to a significant amount of radiation. Placements and insertions are made by the surgeon manually, and this obviously requires a very high degree of precision. The duration of the surgery is long; anaesthesia, incisions and bleeding can be significant, and consequently so is the recovery time.
The technological revolution
The use of robots has entirely changed surgical procedures. Prior to surgery, a virtual 3D model of the patient’s spine is created using a special x-ray technique. This model is then input into the surgical robot, providing it with an extremely accurate image to rely on. The robotic system is equipped with specialised software that analyzes data from various sensors to track the patient’s position on the operating table. It then realigns the patient with a 3D model it has stored, continuously making adjustments to account for even the slightest movements made by the patient. This way the robot always knows its exact location in the patient’s body with pinpoint accuracy. The introduction of such virtual ‘super-vision’, has enabled surgeons to make much smaller incisions and have the robot indicate the positioning of fixation devices. These are then applied precisely where the surgeon had planned, reducing the margin for error to an absolute minimum. In fact the robot’s arm is placed in the exact position by the surgeon, who follows the procedure by controlling everything on a large monitor that displays all the available information.
The result is a minimally invasive surgery, carried out with small incisions, which is completed in a much shorter time (offering all associated benefits). Above all, it is an extremely precise procedure that is carried out according to the surgeon’s pre-operative planning to minimise human error-related risks.
The benefits of robotic spine surgery
From what has been explained so far, it is clear that this new technology offers many benefits. They certainly concern the success of the surgery and the post-operative care of the patient, but the advantages also involve the surgeon, his team and – on a closer look – the healthcare system in general. Let us examine them in detail.
Safety and accuracy
The success of robot-assisted spine surgery is the first and most obvious benefit. The use of robots eliminates all issues related to the steadiness of the surgeon’s hand, thus eliminating potential errors caused by muscle tiredness and fatigue.
Areas that are typically challenging to reach with conventional techniques become easier to access. Other newly established techniques can be used in robot-assisted spine surgery – such as single lateral position, which allows multiple areas to be treated without the need for changing the patient’s position – also making it possible to reduce the time even further.
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Shorter duration of the surgery
The shorter duration of robot-assisted spine surgery compared to traditional surgery has a number of important consequences.
- The patient receives lower doses of anaesthetic. This obviously impacts the time it takes for the patient’s body to wake up and eliminate the anaesthetic.
- The surgical team is subjected to less stress and less fatigue. Several surgeries can be carried out in the course of a day: this is an important advantage for the whole healthcare system as this allows more surgeries and shorter waiting times.
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Minimally invasive approach
Robot-assisted spine surgery is by definition minimally invasive: it is the most minimally invasive procedure. This approach offers all the benefits of the other minimally invasive approaches, aimed at reducing surgical trauma, but it also has its own specific advantages.
Here is an overview.
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- Smaller incisions, which cause less bleeding and less damage to the muscular tissue (muscle bands are often not severed but only moved).
- The post-operative recovery time is shortened, and function and movement are recovered in less time.
- The total length of stay is shorter. This advantage has a positive impact on the healthcare system as well: over a given period of time, a hospital can take care of several patients.
- Overall, the risks of post-operative infections are also lower.
- The technology used drastically reduces exposure to radiation. This applies of course to the patient, but even more so to the entire operating room staff.
What spinal conditions can be treated with robot-assisted surgery?
It is becoming increasingly clear that robot-assisted surgery can be an effective treatment for a growing number of conditions of the spinal column. As the use of robots expands, new techniques are being developed to enhance their capabilities. A case-by-case assessment can be made only by consulting with specialists for each specific condition: a neurosurgeon and a spine surgeon who operate with modern approaches and methods. Nonetheless, robot-assisted spine surgery has already proven to be effective for some of the most common spinal conditions. These include primarily the following.
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Herniated disc.
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Stenosis of the spinal canal.
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Degenerative scoliosis.
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Spondylolisthesis.
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Spondyloarthrosis.
Where to undergo robot-assisted spine surgery in Italy
The introduction of robot-assisted spine surgery is relatively recent. The US Food and Drug Administration’s approval of the first spine robot dates back to 2004. In Italy, the first robot arrived in 2018, at Humanitas Turin Fornaca, followed by nine others. These include the one at Humanitas San Pio X, in Milan (the first and only one currently in Lombardy), and the one at Casa di Cura Rizzola, in San Donà di Piave (Venice). Neurosurgeon and spine surgeon Dr Giuseppe J. Sciarrone, co-director of the Centre for Spine Surgery and Robotics of Humanitas in Milan, performs surgery in both of these renowned facilities at the forefront of spine surgery. Dr Sciarrone, who has already performed 10,000 operations, is currently among the top 5 neurosurgeons and spine surgeons in Europe for number of robot-assisted procedures.
Can you be treated with robot-assisted spinal surgery?
If your condition is among those listed, you may be a good candidate for robot-assisted spinal surgery. Likewise, if you have already been diagnosed with a back condition and prescribed a treatment plan that includes a back surgery, but would like to seek a second opinion, robot-assisted surgery may still be considered as an alternative.
Find out more by booking a consultation with Dr Giuseppe J. Sciarrone, Italian neurosurgeon at Humanitas San Pio X in Milan, Casa di Cura Rizzola in San Donà di Piave (province of Venice), or Casa di Cura Pierangeli in Pescara, among the best centres of excellence for neurosurgery and spine surgery in Italy.
