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European Spine Journal

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14-11-2023 | Original Article

Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study

Authors: Fan Feng, Xiuyuan Chen, Zude Liu, Yingchao Han, Hao Chen, Quan Li, Lifeng Lao, Hongxing Shen

Published in: European Spine Journal | Issue 1/2024

Abstract

Objective

Robot-assisted technology has been gradually applied to pedicle screw placement in spinal surgery. This study was designed to detailedly evaluate the learning curve of junior surgeons in robot-assisted spine surgery.

Methods

From December 2020 to February 2022, 199 patients requiring surgical treatment with posterior pedicle screw fixation were prospectively recruited into the study. The patients were randomized to the robot-assisted group (the RA group) or the conventional freehand group (the CF group). Under the senior specialist’s supervision, pedicle screws were placed by two junior fellows without prior experience. Cumulative summation (CUSUM) analysis was performed on the learning curve of pedicle screw placement for performing quantitative assessment based on the time of screw insertion.

Results

In total, 769 and 788 pedicle screws were placed in the RA and CF groups. Compared with the CF group, the learning duration in the RA group was shorter in the upper thoracic region (57 vs. 70 screws), but longer in the lower thoracic (62 vs. 58 screws) and the lumbosacral region (56 vs. 48 screws). The slope of learning curve was lower in the RA group than in the CF group. The screw accuracy in the RA group was superior to that in the CF group, especially in upper thoracic region (89.4% vs. 76.7%, P < 0.001). This disparity of accuracy became wider in deformity cases. In the upper thoracic region, the mean placement time was 5.34 ± 1.96 min in the RA group and 5.52 ± 2.43 min in the CF groups, while in the lower thoracic and lumbosacral regions, the CF group's mean placement times were statistically shorter. Three screw-related neural complications occurred in the CF group.

Conclusion

Robot-assisted technique has its advantages in the upper thoracic region and deformity cases, which is easier and safer to insert pedicle screws. The robot-assisted technique allowed a short learning curve for junior surgeons and exhibited consistently excellent results even in the early application period.

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Title: Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study
Authors: Fan Feng
Xiuyuan Chen
Zude Liu
Yingchao Han
Hao Chen
Quan Li
Lifeng Lao
Hongxing Shen
Publication date: 14-11-2023
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 1/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-08019-2

At a glance: The STEP trials

Springer Medicine

Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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