scholarly journals Pedicle screw insertion in spine: a randomized controlled study for robot-assisted spinal surgery

10.29007/nbg2 ◽  
2018 ◽  
Author(s):  
Wei Tian ◽  
Mingxing Fan ◽  
Yajun Liu
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Entry Point ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Mean Deviation ◽  
Robot Assisted ◽  
Group Assessment ◽  
Randomized Controlled ◽  
End Point

To introduce a new robot-assisted surgical system for spinal posterior fixation which called TiRobot, based on intraoperative three-dimensional images. TiRobot has three components: the planning and navigation system, optical tracking system and robotic arm system. By combining navigation and robot techniques, TiRobot can guide the screw trajectories for orthopedic surgeries.In this randomized controlled study approved by the Ethics Committee, 40 patients were involved and all has been fully informed and sign the informed consent. 17 patients were treated by free-hand fluoroscopy-guided surgery, and 23 patients were treated by robot-assisted spinal surgery.A total of 190 pedicle screws was implanted. The overall operation time were not different for both groups. None of the screws necessitated re-surgery for revised placement. In the robot-assisted group, assessment of pedicle screw accuracy showed that 102 of 102 screws (100%) were safely placed (<2 mm, category A+B). And mean deviation in entry point was 1.70 +/- 0.83mm, mean deviation in end point was 1.84 +/- 1.04mm. In the conventional freehand group, assessment of pedicle screw accuracy showed that 87 of 88 (98.9%) were safely placed (<2 mm, category A+B), 1 screw fall in category C, mean deviation in entry point was 3.73 +/- 2.28mm, mean deviation in end point was 4.11 +/- 2.31mm.This randomized controlled study verified that robot-assisted pedicle screw placement with real-time navigation is a more accuracy and safer method, also revealed great clinical potential of robot-assisted surgery in the future.

scholarly journals Internal fixation in upper cervical spinal surgery: a randomized controlled study

10.29007/63j9 ◽  
2018 ◽  
Author(s):  
Mingxing Fan ◽  
Yajun Liu ◽  
Wei Tian
Keyword(s):  
Internal Fixation ◽  
Spinal Surgery ◽  
Statistical Difference ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Mean Deviation ◽  
P Value ◽  
Randomized Controlled ◽  
Upper Cervical ◽  
The Mean

Internal fixation in upper cervical spine (C1 and C2) is a big challenge. There is a large anatomical variation, and the upper cervical region is adjacent to important organs such as spinal cords, oblongata, vertebral artery, nerve roots and other important structures, misplacement of internal fixation might lead not only to an instability of the screws, but also to neurological, vascular, and visceral injuries.TianJi Robot was used in this study to compare the internal fixation safety and accuracy between using the navigation based robotic system and free-hand. In this randomized controlled study 51 patients were involved.129 screws were smoothly implanted without intraoperative complications. In the robot-assisted surgery group, the analysis of the screw showed that 58 of 59 screws (98.3%) were safely placed (<2 mm), and the mean deviation between the planned trajectory and the actual path is 1.14 +/- 0.09mm. In the free-hand fluoroscopy-guided surgery and navigation assisted surgery group, assessment of screw accuracy showed that 66 of 70 screws (94.3%) were safely placed (<2 mm), and the mean deviation between the planned trajectory and the actual path is 1.48 +/- 0.14mm. There was no statistical difference in Gertzbein-Robbins classification distribution between these two groups (P value = 0.551), however, the discrepancies between the actual path and planned trajectory in this two groups have statistical difference (P value = 0.047).The TianJi Robot has demonstrated its safety and accuracy in upper cervical spinal surgery upon free-hand technic and the navigation technic, which will have expanded applications in spinal surgery.

scholarly journals Il buttonhole: come trasformare una fistola in un catetere

2013 ◽  
Vol 25 (4) ◽  
pp. 290-292
Author(s):  
Marcello Napoli
Keyword(s):  
Sono State ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Sulla Base ◽  
Randomized Controlled ◽  
End Point ◽  
Sono Stati

La tecnica buttonhole (BT) è un'alternativa alle tecniche standard per l'incannulamento della fistola artero-venosa (AVF). Non è certo se i vantaggi della BT siano superiori ai rischi ad essa associati. Al fine di analizzare la letteratura recente, abbiamo cercato su PubMed le voci “randomized controlled study on buttonhole” e “review of buttonhole cannulation” negli anni tra il Gennaio 2011 e il Novembre 2013. Abbiamo identificato tre studi randomizzati e tre recensioni. Uno studio randomizzato ha mostrato una migliore sopravvivenza delle FAV (100% vs 82%), meno interventi (19% vs 39%) e una minore crescita degli aneurismi preesistenti (23% vs 67%) nel gruppo BT. Un secondo studio ha mostrato un maggior numero di infezioni ed ematomi e una maggiore percezione del dolore nel gruppo BT. Nel terzo studio, non ci sono state differenze nella percezione del dolore e nel tempo di sanguinamento tra il gruppo BT e il gruppo di controllo e sono stati rilevati un maggior numero di ematomi nel gruppo di controllo e un maggior numero di infezioni locali e sepsi nel gruppo BT. Le tre review non hanno mostrato risultati certi riguardo agli end point della BT (percezione del dolore, formazione di aneurismi, tempo di sanguinamento), confermando l'aumentato rischio di infezioni locali e sistemiche. Sulla base di questa analisi, si può concludere che la BT produce un aumento del rischio di infezioni locali e sistemiche senza benefici definiti. Studi recenti suggeriscono di riservare la BT a casi selezionati (vasi particolarmente profondi o tratti troppo brevi). Non si può escludere che ulteriori studi randomizzati e controllati possano produrre un diverso giudizio sulla BT.

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