Introduction: Our limited initial experience with DaVinci robotic system demonstrates feasibility of robotically assisted exposures and surgical procedures for the carefully selected indications. There are only 3 robotic systems commercially available in the United States currently, which are more focused on providing sophisticated guidance for the drills rather than a true robotic "task execution" device.
Methods: Three patients underwent robotically-assisted surgery at the University of Illinois-Chicago from February 2012 through August of 2013. We describe the surgical technique, the advantages of robotically-assisted surgery, and technical limitations.
Results: Patient #1 was a 50 year old male who presented with L5 fracture and first underwent laparoscopic robotically-assisted exposure of the lumbar spine and mobilization of iliac vessels followed by direct extraperitoneal approach to ventral lumbar spine through a small laporotomy incision. Discectomy and anterior interbody arthrodesis was performed using the standard ALIF techniques.
Patient #2 was a 19 year old woman who presented with a 8 x 4 cm paraspinal mass. CT-guided biopsy demonstrated paraganglioma. This mass had some extension into the T9-10 and T10-11 foramina but without any spinal canal involvement. We performed thoracoscopic minimally-invasive robotically-assisted operation and removed the intrathoracic portion of the tumor, leaving small residual in the foramina, which was subsequently treated with frameless radiosurgery.
Patient #3 was a 49-year old patient presented with T7-8 disci tis who underwent robotically-assisted thoracoscopic spine exposure and mini-thoracotomy, followed by T7-8 discectomy, debriedment of osteomyelitic bone tissue, and anterior interbody fusion with expandable cage through a small 6 cm incision using direct vision and thoracoscopic visualization.
Conclusions: Currently robotically-assisted surgery could be performed for a very limited number of indications. It is authors´ opinion that it could be of a significant practical interest to develop the robotic systems, which will be focused on a image-guided task execution and simultaneous implant delivery.
Patient Care: We believe that with the future development of robotic automation systems we will be able to improve the prevision of implant placement, shorten the operative time and decrease the incidence of malpositioned instrumentation.
Learning Objectives: To identify indications for robotically-assisted procedures, determine the workflow of the surgical procedure, and the technical limitations of the existing robotic systems