title: Robotic approaches to the posterior spine.
abstract: METHODS
  This anatomic study described robotic approaches to the posterior thoracolumbar spine in a porcine model. Ergonomics, control, and approach and technical difficulties were noted.
  
  
  OBJECTIVE
  The objective of this study was to develop a robotic approach to the posterior thoracolumbar spine maximizing surgeon ergonomics and control.
  
  
  BACKGROUND
  Surgery is both physically and mentally demanding, and strains from ergonomics and the aging process may negatively impact surgical skills. In spine surgery, control and precision are extremely important due to the close proximity to the spinal cord. The da Vinci robotic surgery system has offered better ergonomics and control in urology, gynecology, and cardiac surgery, and is rapidly gaining adoption. To date, there have been no published reports of da Vinci robotic spine surgery, motivating us to assess its potential in posterior spine surgery.
  
  
  METHODS
  Posterior spine da Vinci approaches were tested on a pig without spinal pathology with an open subperiosteal dissection. A laser instrument and prototype robotic burr and rongeur instruments were tested on laminotomy, laminectomy, disc incision, and dural suturing procedures.
  
  
  RESULTS
  Open dissection of the posterior spine provided sufficient access to successfully perform laminotomy, laminectomy, disc incision, and dural suturing procedures. Prototype burr and rongeur instruments were effective with good control. The laser instrument coagulated the epidural venous plexus and incised the anulus. Robot ergonomics allowed the surgeon to perform procedures for a full day with significantly less fatigue and reduced hand tremor.
  
  
  CONCLUSIONS
  The da Vinci could perform the major noninstrumented procedures of the posterior spine with improved ergonomics and control. Surgeon fatigue and tremor were reduced. With some modification of prototype and commercial instruments a posterior spine surgery instrument kit can be developed. Future clinical studies can better assess patient and surgeon benefits of using the da Vinci robot for posterior spine surgeries.
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Ponnusamy
authors.forename: Samuel
authors.initials: S
authors.lastname: Chewning
authors.forename: Catherine
authors.initials: C
authors.lastname: Mohr
mesh_terms: D000818:Animals; D002983:Clinical Competence; D004867:Equipment Design; D006804:Ergonomics; D005221:Fatigue / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007796:Laminectomy; D017075:Laser Coagulation; D008159:Lumbar Vertebrae / Q000601:surgery*; D023421:Models, Animal; D009048:Motor Skills; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013536:Suture Techniques; D013552:Swine; D013904:Thoracic Vertebrae / Q000601:surgery*; D014202:Tremor / Q000517:prevention & control