A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
January 6th, 2023
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.
Transiliac-transsacral screw fixation is a challenging task in clinical practice. The teleoperated robotic system-assisted surgery offers a solution to the difficulty of transiliac-transsacral screw placement. Using this technique, surgeons can perform procedures outside the operating room, thus avoiding the danger of radiation exposure.
Additionally, robot-assisted surgery has a higher position-retention capacity compared with the conventional method. This technology can be combined with 3D navigation, virtual reality, augmented reality, and mixed-reality technologies for percutaneous screw placement in the pelvic acetabulum. For efficient fixation, doctors should be skilled in placing the sacroiliac screws using freehand under fluoroscopy prior to using this technique.
To begin, fix the cadaveric pelves in the supine position using a fluoroscopic plate base 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. Using the Med CAD module of the preoperative planning software, create a cylinder of the pelves'image and define the size of the cylinder by typing in the diameter and length.
Place the cylinder into the S1 or S2 vertebral body and adjust the orientation of the cylinder midline on the axial and coronal images. Check the relationship between the edge of the cylinder and the cortical bone in each image. Fix the pelvis in the supine position on the fluoroscopic operating table.
Then place the robot on the ipsilateral side at 45 degrees to the operating table, with the C-arm perpendicular to the operating table on the contralateral side. Next, place the workstation of the master manipulator outside the operating room. Fix the grid position maker with adhesive tape on the ipsilateral side.
Select the target area by a grid position marker on the true lateral view of the sacrum. Ensuring that the manual traction mode on the console is selected and started, drag the robotic arm to the general area of the S1 or S2 transiliac-transsacral screw entry point. Visualizing the true lateral view of the sacrum, operate the master manipulator in the master-slave operation mode, and adjust the tip of the distal sleeve to be located in the guidewire entry area.
After selecting the remote center of motion, or RCM, mode, continue the C-arm fluoroscopy for the lateral sacral view. Adjust the center of the guidewire sleeve into concentric circles to be consistent with the screw channel. Lock the robotic arm and insert a 2.5 millimeter guidewire through the contralateral ileum using an electric drill.
Then remove the robot in manual traction mode. Turn the C-arm to the inlet and outlet angles to check that the guidewire has broken through, or contacted the interior and posterior sacral cortex and the sacral nerve canal. Insert a 7.3-millimeter semi-threaded screw along the guidewire to the contralateral iliac cortex.
Assess the screw position in the pelvic inlet, outlet, and lateral view. Import the acquired CT scan data into the pre-operative planning software in the DICOM format, to obtain the screw position in coronal, sagittal, and axial images of the pelvis. Post-operative CT reconstruction images and X-rays to evaluate the screw placement showed that no screws penetrated the cortical bone, and all the screws were completely in the cancellous bone.
Sagittal CT reconstruction images of the midline site suggested that the screw is located in the S1 and did not enter the sacral canal, as seen on the reslice axial image. Also, the screw is safe, as seen on the reslice coronal CT reconstruction image. The true lateral view of the sacrum revealed that the screw is located entirely within the bone and is at a safe distance from the anterior and posterior sacral cortex and the sacral nerve canal on the inlet and outlet images.
Remote controlling of this procedure is possible. The key things in this protocol are the accuracy and stability of the master-slave operation mode and RCM mode. This method is expected to become an essential part of telemedicine in the future.
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Overview
Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation is a promising technique that enhances surgical precision. This method allows for procedures to be performed outside the operating room, minimizing radiation exposure risks.
Key Study Components
Area of Science
- Robotic Surgery
- Orthopedic Surgery
- Minimally Invasive Techniques
Background
- Transiliac-transsacral screw fixation presents significant challenges in clinical settings.
- Traditional methods expose surgeons to radiation during fluoroscopy.
- Robotic systems provide enhanced stability and movement.
- Integration with advanced technologies like 3D navigation improves outcomes.
Purpose of Study
- To evaluate the feasibility of robotic-assisted screw fixation.
- To assess the accuracy of screw placement using robotic systems.
- To explore the potential for performing surgeries outside conventional operating rooms.
Methods Used
- Teleoperated robotic system for screw placement.
- Combination with 3D navigation and augmented reality.
- Pre-surgical training in freehand screw placement under fluoroscopy.
- Evaluation of position-retention capacity compared to conventional methods.
Main Results
- High accuracy in screw channel implementation.
- Improved safety by reducing radiation exposure.
- Enhanced stability and freedom of movement of robotic arms.
- Positive outcomes in robotic-assisted surgeries.
Conclusions
- Robotic-assisted percutaneous screw fixation is a viable technique.
- Surgeons can benefit from training in traditional methods before adopting robotic systems.
- Future studies should explore further integration of robotic systems with advanced technologies.
Frequently Asked Questions
Executive Industry Relevance
Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation addresses the challenge of precise hardware placement in complex anatomical regions, reducing the risk of neurovascular injury. The integration of remote robotic control and advanced imaging enhances procedural accuracy and operator safety, supporting critical decision points in device development and surgical innovation. This capability is strategically relevant for biopharma R&D teams focused on enabling next-generation surgical platforms and translational device validation.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables rigorous evaluation of device-tissue interaction and mechanical stability in preclinical models.
- Supports mechanistic de-risking by providing reproducible, high-precision placement data.
- Facilitates functional validation of robotic-assisted interventions for translational device programs.
Screening & Assay Development
- Prepares validated anatomical models for downstream device testing and imaging workflows.
- Standardizes procedural steps to ensure reproducibility and quantitative assessment of device performance.
- Enables reliable evaluation of new hardware or biomaterials in controlled settings.
Translational & Preclinical Research
- Aligns with disease-relevant models for orthopedic and trauma device development.
- Supports continuity from benchtop validation to preclinical safety and efficacy studies.
- Provides predictive confidence for advancing robotic-assisted surgical technologies toward clinical translation.
Pipeline & Workflow Integration
This teleoperated robotic system fits within the continuum from device concept validation through preclinical testing and translational research, supporting iterative optimization and risk-adjusted advancement.
- Discovery Biology: Enables hypothesis testing on device placement accuracy and anatomical safety margins.
- Screening: Provides standardized, reproducible workflows for evaluating device prototypes and procedural variables.
- Analytics: Delivers quantitative imaging outputs (CT, fluoroscopy) for objective comparison of device positioning.
- Translational Research: Bridges preclinical validation with clinical feasibility by demonstrating remote operation and safety.
- Enterprise Reuse: Establishes a reusable platform for diverse device and procedural innovation studies.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in device safety and placement accuracy.
- Operational Value: Standardizes complex procedures, reducing operator variability and radiation exposure.
- Strategic Value: Enables robust go/no-go decisions for device advancement and supports capital-efficient R&D.
- Portfolio Impact: De-risks translational device programs and informs prioritization of surgical technology investments.
Implementation Considerations
- Requires expertise in robotic system operation and anatomical imaging interpretation.
- Needs access to advanced imaging modalities (CT, fluoroscopy) and compatible robotic platforms.
- Demands cross-team standardization for procedural reproducibility and data comparability.
- Adaptation may be needed for different anatomical models or device types.
- Practical limitations include the learning curve for remote operation and integration with existing OR workflows.
