Introduction: Illumination and magnification during lumbar spine surgery to improve visualization is achieved in multiple ways. This can include the use of the operative microscope, loupe magnification with a headlight or endoscopic camera systems. The use of an advanced optical system with an integrated light source, coupled with robotic technology for positioning, represents an evolutionary advance in the performance of lumbar spinal surgery.
Methods: Between March 1, 2015 and December 31, 2015, 100 consecutive lumbar spine surgeries were performed by a single surgeon at a single institution. Average surgical time and presence or absence of intraoperative incidental durotomy was recorded for each case. High-definition intraoperative video was recorded to evaluate optical technology and surgical workflow.
Results: The authors experienced a 75% decrease in incidental durotomy with the use of the advanced optical system over time. Average surgical time with the use of this robotics optical guidance platform improved to an average of 56.1 minutes for single-level tissue preserving surgeries (Medtronic METRx).
Conclusions: This review represents the first recorded report of this system exclusively in the use of lumbar spine surgery. Advantages of the robotic optics positioning system include:
-Enhanced surgical focus volume measuring 5cm x 5cm x 5 cm, provides improved visualization of the surgical field and eliminates point focusing issues seen with use of a surgical microscope or loupe magnification.
-Equal visualization and access to the surgical field for 2 surgeons.
-Improved ergonomics of surgeon and assistant by eliminating extreme and prolonged positions required with traditional methods.
-Vastly improved visual trajectories with uniform illumination allowing greater access to the extreme margins of the surgical field.
-Obviates the need to “switch” sides during the procedure.
-Synergy and enhancement of visualization with MIS tubular systems.
-With enhanced visualization and improved ergonomic workflow, the rate of incidental durotomy can be significantly reduced with the use of an advance robotic optical guidance system.
Patient Care: Improved visualization of the surgical field, increased operative efficiency and improved surgical ergonomics enhances the safe conduct of lumbar spine surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the optical properties of ROVOT-m, 2) Discuss the benefits and limitations of the ROVOT-m in lumbar spine surgery, 3) Discuss the implications of a larger immersive surgical volume for lumbar spine surgery.