title: Robotic-assisted minimally invasive surgery of the spine (RAMISS): a proof-of-concept study using carbon dioxide insufflation for multilevel posterior vertebral exposure via a sub-paraspinal muscle working space.
abstract: BACKGROUND
  Open posterior spinal procedures involve extensive soft tissue disruption, increased hospital length of stay, and disfiguring scars. Our aim was to demonstrate the feasibility of using robotic-assistance for minimally invasive exposure of the posterolateral spine with and without carbon dioxide (CO2) insufflation.
  
  
  METHODS
  Sheep specimens underwent minimally invasive subperiosteal dissection of the spine during three trials. The da Vinci S Surgical system was used for access with and without working space support via CO2insufflation.
  
  
  RESULTS
  Without insufflation, a sub-paraspinal muscle tunnel measuring 16 cm was developed between two 5 cm incisions. With insufflation, the one-sided tunnel length was 12.5 cm but without the soft tissue trauma and obstructed visualization experienced without CO2.
  
  
  CONCLUSIONS
  The use of robot-assistance for minimally invasive access to the posterior spine appears to be feasible. The use of CO2insufflation greatly improved our ability to visualize and access the posterior vertebral elements.
authors.affiliation: Department of Surgery, Sidra Medical and Research Center; Department of Orthopedic Surgery, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Howard
authors.affiliation: Qatar Robotic Surgery Centre, Qatar Science & Technology Park, Doha, Qatar.
authors.forename: Julien
authors.initials: J
authors.lastname: Abinahed
authors.affiliation: Qatar Robotic Surgery Centre, Qatar Science & Technology Park, Doha, Qatar.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Navkar
authors.affiliation: Qatar Robotic Surgery Centre, Qatar Science & Technology Park, Doha, Qatar.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Peyrat
authors.affiliation: Urology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Abdulla
authors.initials: A
authors.lastname: Al-Ansari
authors.affiliation: Department of Surgery, Sidra Medical and Research Center; Department of Surgery, Weill Cornell Medical College, Doha, Qatar.
authors.forename: David L
authors.initials: DL
authors.lastname: Sigalet
authors.affiliation: Department of Surgery, Sidra Medical and Research Center; Department of Surgery, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
mesh_terms: D000818:Animals; D002245:Carbon Dioxide; D006801:Humans; D007327:Insufflation; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008953:Models, Anatomic; D023421:Models, Animal; D064170:Paraspinal Muscles / Q000601:surgery; D000075082:Proof of Concept Study; D065287:Robotic Surgical Procedures / Q000379:methods*; D034561:Sheep, Domestic; D013131:Spine / Q000601:surgery*
chemical_list: D002245:Carbon Dioxide
keywords: MIS; carbon dioxide insufflation; endoscopy; minimal invasive surgery; orthopaedic; pediatrics; posterior spine; robotic surgery; scoliosis; single-port; spine; telesurgery