This robot-assisted navigation system is very effective, accurate, and safe. It provides a friendly user interface and automatically compensated handpiece for pedicle screw replacement. The point handpiece of this system has a parallel platform architecture, which has the advantages of a strong load capacity, fast positioning speed, portability, small footprint, and high curvability.
This system can be used to perform minimally invasive surgeries, complicated kyphoid scoliosis deformities and other challenging cases. We plan to use the Robotics system in other surgical procedures such as nerve decompression. In contrast to a traditional surgical methods, this system uses a unique technology that allows visualization of the surgical goals and operation steps within the application interface.
Demonstrating the procedure with me will be Chin-Wei Chen and Xiu-Yun Xiao, engineers from Point Robotics. After anesthesia and draping, place one percutaneous wire with a ply of 1.5 millimeters on the posterior iliac crest to anchor the fiducial frame to the iliac bone of the saw bone and check the entry point under fluoroscopy. Mark the entry point with ink.
Use a power drill set to 1, 000 revolutions per minute to insert the first percutaneous pin into the patient's posterior iliac crest. Use the pin to anchor fiducial frame and adjust the frame until it is recognized by the optical tracking camera. When the frame is in position, use a screwdriver to fix the frame to the pin and use the drill to insert the second percutaneous pin, further securing the frame with the second pin.
Mark the surgical field with ink and use a surgical scalpel to make a skin incision along the mark. Then, use a screwdriver to fix the frame to the spinal process of interest and have the surgeon confirm that the frame has been firmly anchored. For spatial labeling and registration, enter the dynamic reference frame monitoring interface to the Point Spine Navigation System software with multiple planar views.
All of the dynamic reference frames should be inside the vision area of the optical tracking system. When the dynamic reference frame vector arrow is displayed, the tracker has been stably recognized by the tracking system. To ensure a correct registration, select at least four non-coplanar feature points on the patient's pre-operative 3D reconstruction CT images.
Use the tip of the probe to keep in contact with the first feature point within the actual surgical area. Then press Probe Selection'to confirm the access point. When all of the feature points have been confirmed, press Calculation'The system will calculate the result of the landmark registration and present it in the software interface.
When the acceptance criteria for the registration accuracy meets the needs of the clinical indications, use the probe tip. Continuously contact any point on the bone surface in the actual surgical area and press the Probe Selection'button to confirm the access points. When at least 50 pic points have been confirmed, press Calculation'The system will calculate the surface matching result and present it on the software interface.
Once the registration result has been accepted, use the probe to select the obvious anatomical landmarks of the actual surgical area for confirmation. To assemble the robot, angle the handpiece in space so that the two circles representing the angle of the handpiece coincide in the software interface. Then, horizontally and vertically adjust the position of the handpiece, so that the dots representing the position of the handpiece in the software interface are aligned with the entry points of the planned path.
We recommend becoming familiar with the first person orientation of the user interface and the movement we have here of the handheld robot before attempting a surgery. To prepare the pedicle, activate the drill function of the handpiece and drill the instruments mounted on the front end along the planned path. Use the C-arm to confirm the position of the K-pin and the trocar and use the anterior/posterior view to determine whether the instrument is located in the oval area formed by the pedicle in the perspective image.
Then, under the lateral view, determine whether the instrument is within the range of the pedicle and the vertebrae. When the K-pin and trocar positions are appropriate for the procedure, replace them with guide wires and insert the pedicle screws through the guide wires. In a previous study, a low-overall screw malposition rate of 1.7%from a total of 59 screws placed on 34 seen vertebrae through the Point Spine Navigation System was demonstrated.
No spinal canal perforations or injuries to any other major vessels were observed and all of the pedicle screws were positioned within the safe zone. The robot can, not only drill, but also perform even soft tissue manipulations because of the high accuracy of robot, many surgical procedures can be performed safely. Our team is currently focusing on making the user learning curve easier and providing a supporting arm to reduce the weight of the handpiece.
