A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique

Summary

Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation is a feasible technique. Screw channels can be implemented with high accuracy owing to the excellent freedom of movement and stability of the robotic arms.

Abstract

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. Transiliac-transsacral screws provide a longer lever arm to withstand the perpendicular vertical shear forces. However, the screw channel is so long that a minor discrepancy can lead to iatrogenic neurovascular injuries. The development of medical robots has improved the precision of surgery. The present protocol describes how to use a new teleoperated robotic system to execute transiliac-transacral screw fixation. The Robot was operated remotely to position the entry point and adjust the orientation of the sleeve. The screw positions were evaluated using postoperative computed tomography (CT). All the screws were safely implanted, as confirmed using intraoperative fluoroscopy. Postoperative CT confirmed that all the screws were in the cancellous bone. This system combines the doctor's initiative with the Robot's stability. The remote control of this procedure is possible. Robot-assisted surgery has a higher position-retention capacity compared with conventional methods. In contrast to active robotic systems, surgeons have full control over the operation. The robot system is fully compatible with operating room systems and does not require additional equipment.

Introduction

The first robotic application utilized in orthopedic surgery was the ROBODOC system employed in 1992¹. Since then, robot-assisted surgical systems have rapidly developed. Robot-assisted surgery improves arthroplasty by enhancing the surgeon's ability to restore the alignment of the limb and the physiological kinematics of the joint². In spinal surgery, the placement of pedicle screws using a robot is safe and accurate; it also reduces the surgeon's radiation exposure³. However, studies on robot-assisted surgery have been limited owing to the heterogeneity of traumatic orthopedic diseases. ....

Protocol

The application of this robotic technique was approved by the ethics committee of the Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, and it complies with the Helsinki Declaration of 1975, as revised in 2013.

1. Preoperative planning

1. Fix the cadaveric pelves in the supine position using a fluoroscopic plate base (see Table of Materials) by inserting two Schanz pins through the femur. In the supine position, place both the posterior superior iliac spines simultaneously on the plank and the lumbar vertebrae parallel to the floor.
   NOTE: The donated c....

Results

A senior orthopedic surgeon completed the surgery using the procedure described. All the screws (three in S1 and two in S2) were secured. The time taken (from the first X-ray fluoroscopy to the insertion of the screw) for inserting each of the five screws was 32 min, 28 min, 26 min, 20 min, and 23 min, respectively. The fluoroscopy time for each screw was approximately 5 min. Although all the screws were in the correct place on the intraoperative fluoroscopic images, several articles have highlighted the need for postope.......

Discussion

Regardless of the type of Robot, the core application of robots in orthopedics provides an advanced tool for surgeons to improve the accuracy of surgery. However, the emergence of surgical robots is not a replacement for doctors. Surgeons performing robotic surgery may or may not be in the operating room. Surgical robots generally include a computer control system, a robotic arm responsible for the operation, and a navigation system responsible for tracking. There are three categories of robot systems depending on how th.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
160-slice CT	United Imaging Healthcare Surgical Technology Co. Ltd	uCT780	Acquire the prescise image and DICOM data
Electric bone drill	YUTONG Medical	None	Power system
Fluoroscopic plate base	None	None	Fix the cadaveric pelves to operating table
K-wire	None	2.5mm	Guidewire
Master-Slave Orthopaedic Positioning and Guidance System	United Imaging Healthcare Surgical Technology Co. Ltd	None	A teleoperated robotic system that positions screws for orthopaedic surgery
Mimics Innovation Suite	Materialise	Mimics Medical 21	Preoperative planning software
Mobile C-arm	United Imaging Healthcare Surgical Technology Co. Ltd	uMC560i	Low Dose CMOS Mobile C-arm
Operating table	KELING	DL·C-I	Fluoroscopic surgical table
Schanz pins	Tianjin ZhengTian Medical Instrument Co.,Ltd.	5.0mm	Fix the cadaveric pelves
Semi-threaded screw	Tianjin ZhengTian Medical Instrument Co.,Ltd.	7.3mm	Transiliac-Transsacral Screw
Seven DOF manipulator	KUKA, Germany	LBR Med 7 R800	Device for performing surgical operations