Robotics and Computers in Minimally Invasive Spine Surgery

Peer Reviewed

Robotics imageMinimally invasive spine surgery has recently been advanced with the use of endoscopes, improvements in camera equipment and advances in medical robotics. The advantages to the patient are less pain, smaller incisions, fewer complications and a more rapid return to normal activity when compared to conventional surgery. Surgeons are now able to remove a ruptured disc using a small endoscope, repair a painful disc using electro thermal energy and fuse a painful degenerated disc with the aid of a miniature camera and incisions no larger than ½ inch. Robotics and computers are now playing an expanding role in assisting the surgeon in these minimally invasive procedures.

The idea of robotics in surgery got its start in the military. The idea was to develop technology where a surgeon could perform an operation from a remote location on an injured soldier in the battlefield. This concept has evolved into robotics to enhance surgical performance. In this instance, a robotic arm called Endowrist performs the procedure with the surgeon guiding the robotic arm from a location in or adjacent to the operating room. The surgeon sits at a station peering at a monitor that shows a magnified view of the surgical field. A computer mimics and enhances his hand movements. The computer in this instance makes the movements more precise by dampening even a tiny tremor in the surgeon's hands, which might increase the difficulty in performing procedures under high power microscopic magnification.

Examples of such procedures now being performed that were extremely difficult if not impossible before this technology are fallopian tube repair in women, microsurgery on the fetus, and minimally invasive coronary bypass surgery. The Zeus robot made by Computer Motion and a similar device, the Endowrist made by Intuitive Surgical are now in clinical trials for the above-mentioned procedures. Even with the robot to enhance the surgeon's ability, a great deal of practice is required to master the technique.

Robots are also used to help in performing tasks, which are either boring or fatiguing for humans. This idea formed the basis to develop Aesop, a voice-activated robotic arm that holds the camera and endoscope assembly for the surgeon during an endoscopic procedure. Not only does this reduce the need for a person to be required to do this task, but in most instances Aesop does a better job by moving precisely where the surgeon commands the robot, providing a rock-steady image and never fatiguing. To do all this, the surgeon must first make a voice card of all the commands so that the robot can recognize the command with minimal chance of error in interpretation of the voice signal. Once this is done the surgeon must repeat the command in a similar speaking voice. If the surgeon's voice raises or becomes angry, the robot usually stops responding. One might think that in this instance the robot is acting to program the surgeons' behavior.

aesop minimally invasive spine surgery surgeon surgery monitor color photo msd
 
Aesop is a voice -activated robotic arm that holds the camera and endoscope assembly for the surgeon during an endoscopic procedure.
 

Hermes, or Voice Activated Operating Room, allows the surgeon to command adjustments in the camera such as light intensity, raising and lowering the operating table, turning power sources on and off and even making an outside phone call when consultation is needed. In the very near future it is expected that the patients' diagnostic studies such as MRI and CAT scans will be transmitted to a flat panel monitor in the operating room for the surgeon to review during the procedure.

image guided surgery robotics minimally invasive spine surgery color photo
Hermes, or Voice Activated Operating Room, allows the surgeon to command adjustments in the camera such as light intensity, raising and lowering the operating table, turning power sources on and off and even making an outside phone call when consultation is needed.

Computers are also being used in image guidance systems to give the surgeon real time images and allow him to navigate to the specific location on the spine. The surgeon can use digital information obtained before surgery such as MRI or CAT scans or use real time fluoroscopic x-rays to develop a three dimensional image of the spine with the exact location of a probe placed on the spine. This technology has been shown to minimize errors in placement of pedicle screws that are sometimes used to fix the spine. It is also expected that this technology will expand to allow more precise targeting of the problem with minimal incisions and fewer surgical complications.

The use of robotics and computers in minimally invasive spine surgery has resulted in more accurate surgical procedures, shortened operative time and fewer complications. It is expected that Computer Enhanced Image Guidance Systems will improve the precision of these procedures as a result of real time 3-D imaging at the time of the surgery. Diagnostic studies will be digitally transmitted to the operating room and projected to monitors to further aid the surgeon in performing the correct procedure with minimal trauma to the patient.

One vivid image we have of computers and artificial intelligence comes from the computer Hal in 2001, A Space Odyssey. We can't resist thinking of robots as possessing human qualities. In fact, the Aesop robot has been programmed to give the surgeon a compliment. When the surgeon feels he or she has done a good job, the surgeon voices the command "compliment" at the end of the surgical procedure. Aesop will then respond, "You are a great surgeon". Even robots know that compliments go a long way.

Updated on: 03/04/16
Continue Reading
Lumbar (Low Back) Surgical Implants
Edward C. Benzel, MD
Doctor Regan has provided an insightful look into the future, which is now. Spine surgery is advancing rapidly and is on the verge of applying some very remarkable technology to the clinical arena. Dr. Regan’s article provides a wonderful overview of this subject.
SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete
Continue Reading:

Lumbar (Low Back) Surgical Implants

Implants are devices (such as cages, rods, screws) that, when combined with bone graft, stabilize the low back.
Read More