Comparison: Physician-performed MIS spine and robot-guided procedures

Written by Robert Fink, MD, of Gold Coast Orthopaedic Spine & Hand Surgery | November 03, 2016 | Print  |

The field of minimally invasive spine surgery has evolved immensely during the last 10 to 15 years. The procedure is keeping up with the recent progress of technology and science in general. With incredible evolution in the technology niche, physicians and scientists are able to work on new methods and approaches to treatment of disorders or injuries affecting the spine. The primary purpose of the new technology is to help patients improve quality of life and minimize any potential damage. Besides standard MIS, physician-guided robotic procedures have become popular among surgeons.

Robotic surgery — goal
An interesting paper from Annals of Surgery discusses robotic surgery and leads us back to 1921 when Czech playwright Karel Capek introduced the idea and coined the term, robot, in his play "Rossum's Universal Robots." The robot comes from the Czech word, 'rabota,' meaning forced labor. Since then, robots have become widely popular, not just only in Hollywood movies, but in science and medicine as well.


At first, robots were considered to be dumb machines that perform menial, repetitive tasks, but now they are widely used for scientific and medical purposes, including minimally invasive surgeries. The history of MIS started in 1987 with the first laparoscopic cholecystectomy. During the last 29 years, the list of procedures performed in a non-invasive manner has increased significantly.


The advantages of MIS are very popular among surgeons, patients and insurance companies. Incisions are small, thus leaving a small scar, patients have low risk of developing infections, and so on. A growing body of evidence confirms that MIS shortens the hospital stay and speeds up the recovery. Although very efficient, the field of MIS has certain limitations at the same time. Some of the most distinguished limitations involve the technical and mechanical nature of the equipment.


Moving laparoscopic instruments while watching a video of what's going on inside the patient's body can be counterintuitive. The surgeon has to move the tool in the opposite direction from the desired target on the monitor to interact with the affected area. Although these video streams have become more advanced lately, they still require a great deal of concentration. One tiny mistake could create a substantial damage. That's why hand-eye coordination during MIS can be severely disrupted. It's also important to mention that some instruments have limited degree of motion. These seemingly small limitations make more delicate dissections and anastomoses difficult or impossible. Led by a desire to implement new technology and go past these limitations, robotic surgery was invented. From its very inception, robotic surgery was meant to extend the capabilities of human surgeons beyond the limits of conventional surgical procedures.


Physician-performed and robotic spine surgery comparison
MIS spine is created to resolve a number of disorders and injuries affecting spine in a less traumatic manner. Open surgery requires long incision and it is associated with greater blood loss, higher risk of infections, longer hospital stay and overall recovery. On the other hand, MIS spine leaves a tiny scar, it's cost-effective, and the patient recovers much faster.


The goal of physician-guided robotic surgery is to overcome the limitations associated with physician-performed MIS spine in a bid to maximize patient function and accelerate a return to a full life. The focus is on minimizing trauma to the body during surgery and expediting a return to function through non-invasive techniques.


Robotic spinal surgery can be considered as a complementary extension of the current MIS spine techniques. It improves the accuracy of spinal instrumentation and minimizes the use of radiation during surgery.


Today, the Mazor Robotics Renaissance System is widely used for implanting devices in spinal surgery. The system allows the surgeon to use the images from a computerized tomography scan taken before surgery to create a blueprint for a procedure. This adds to the individualized approach to the spinal surgery. Information from the CT scan is loaded into the computerized 3D planning system, which enables the surgeon to plan the procedure with high precision before even entering the operating room.


There's a perfect reason why the term complementary extension is used above; it's because the surgeon is still the one who does all the physical work during the operation while the robotic system is, simply, a tool that guides surgeon instruments based on the accurate pre-operative planning of spinal implants placement.


Benefits of robotic surgery
Just like physician-performed MIS spine, robotic spinal surgery is constantly evolving. That's one of main advantages this approach towards relieving the spinal problem, and it's one of many things that physician-performed and robot-guided operations have in common. Similarly to the standard MIS spine, robotic surgery aims to alleviate a particular condition or injury without causing excessive blood loss, infections, severe postoperative pain, and so on. The procedure is characterized by high degree precision and accuracy which reduces chances of recurrence of the same problem, subsequent surgeries and complications.


Both 'standard' and robotic MIS spine are usually performed on patients suffering from excruciating pain, limited motion and degenerative conditions such as scoliosis, pinched nerves, slipped vertebra and so on. With continuous advancements in this field, we can expect more demanding procedures to be operated in this manner as well.


MIS spine surgery vs. robot-guided procedures conclusion
Robotic surgery is invented to conquer the obstacles that conventional MIS can not pass. That's why benefits of the standard and robotic approach are similar. The robotic system is, simply, a tool that surgeons use for maximum accuracy and precision in order to put less stress and trauma on the affected area. As with everything, there is a time and place for each procedure method depending on the individual obstacles.


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