Spine Surgical Robotics

Currently, surgical robots are increasingly recognized as a prominent example of artificial intelligence technology. Moreover, utilizing surgical robots for medical procedures is seen as a direction for future advancements in surgery.

Surgical robots, such as the Da Vinci, which consist of a combination of advanced medical technologies, have been widely utilized in general surgery. Furthermore, various generations of robots specifically designed for spine orthopedics have also been developed.

The purpose of designing these robots is not limited to providing greater precision to surgeons. They also aim to eliminate errors caused by human intervention, enhance the efficiency of surgeries, and fulfill the requirements of minimizing postoperative complications.

Limited Application In Spine Surgery

Some of the most commonly occurring spine disorders include disc herniation, degenerative changes to the spine, spondylolisthesis, and vertebral fractures. These conditions typically require surgical intervention using a nail-stick fixation system.

Although the morbidity rate is not very high, the conventional method of freehand pedicle screw insertion can result in pedicle damage and screw dislocation, which can lead to significant clinical complications like dural bruising, neurovascular injury, and damage to the muscles and internal organs.

The development of robotic assistance for spine surgery was primarily intended to improve the precision and convenience of pedicle screw placement while reducing the occurrence of manual errors and postoperative complications. As reported by the literature, it appears that robots are primarily used for the insertion of screws in spinal internal fixation procedures, and there are not many other applications of this technology that have been introduced yet.

It is certain that in the future, spine robots will have a wider range of applications beyond simply assisting surgeons with pedicle screw placement. The use of spine robots should also contribute to a comprehensive and multidimensional approach to performing different surgical methods for various diseases.

Limited Operation Site Of Spine Robots

Most of the research on robot-assisted spine surgery has focused on the lumbar or lumbosacral vertebrae, with only a small percentage of studies examining other segments of the spine. One possible reason for the lack of attention to clinical studies on robot-assisted surgery for the cervical and thoracic vertebrae could be that this technology is still in a relatively early stage and the accuracy and stability of robot execution cannot yet be guaranteed.

Additionally, the vital importance of the peripheral nerves, blood vessels, and other anatomical structures in these regions may also contribute to researchers’ hesitation to conduct more extensive clinical studies.

Assuming that the accuracy and stability of the robot can be ensured, there is immense potential for the application of robot-assisted surgery in the cervical and thoracic vertebrae segments. Robotic assistance is expected to improve the accuracy, speed, and convenience of cervical and thoracic spine surgery in some manner.

Furthermore, the upper cervical vertebrae are closely connected to the anatomy of the skull base, and surgeries in this segment are often closely associated with neurosurgery. The application of the Mazor Robotics™ system is being expanded to include brain surgeries, such as the placement of deep brain stimulation (DBS) electrodes.

Errors That Occur Before, During, And After Surgery, And Compound Each Other

Robots designed for surgical assistance aim to enhance accuracy, stability, convenience, and minimize human error by utilizing the latest technologies at every stage. Despite the intended benefits of surgical robots, errors can still occur during the actual clinical use.

Errors can occur at any stage of surgery, including before, during, or after the procedure, and these errors can accumulate, leading to larger deviations and potential risks that may impact the quality of the operation and even threaten the safety of the patient.

This issue is particularly significant in spine surgery, where the accuracy of pedicle screw fixation is crucial, as an incorrect screw placement can result in severe damage to the spinal cord, nerves, and critical vessels. In contrast to the flexible and manual adjustments made by humans, robots are not as effective at avoiding errors due to their higher stability and complex parameters, and there are various factors that can reduce the precision of robotics.

An example of this is when the casing is positioned at the inlet, which could result in lateral skidding. During the drilling process, the pressure applied can potentially cause displacement of the vertebral body being measured. The robot’s software may introduce errors due to parameter settings, and the manner in which the robot is attached to the spine should also be taken into account.

It’s important to be aware that the bed mount fixation may not be strong enough, which can lead to movement between the robot and the patient. This error in mounting could result in lateral deviation. Soft-tissue pressure should also be considered as a factor that can cause deviation on the robotic arm. Thick and tough tissues can cause the robot’s drill to deviate due to the high pressure applied by the robot.

Questioning The Advantage Of Spine Surgery Robots

Currently, the assessment outcomes of robot-assisted pedicle screw insertion predominantly consist of factors such as screw placement accuracy, radiation exposure/time, surgical duration, blood loss, and so on.

While literature has shown positive results for robot-assisted pedicle screw placement, with the experimental group outperforming the control group (which may use methods such as fluoroscopy or freehand techniques), there are still some articles that present different opinions on the matter. Surgeons may find robot-assisted systems less attractive when the anatomy is already clear, as there is no advantage in accuracy over conventional freehand surgery.

One randomized controlled trial found that the use of the Mazor™ robot for screw placement actually decreased accuracy. A question regarding the precision of the robot may arise from various factors such as preoperative planning, quality of imaging, and intraoperative manipulation. Most robotic systems still require the surgeon to verify, fine-tune or manually plan the automatic calculation of the robot’s parameters.

The accuracy and efficiency of planning are dependent on the processing of image correction and the pattern of the image. Currently, the fusion of 2D and 3D multi-mode images can be achieved automatically, but it may be time-consuming or may not achieve high precision for complex cases.

The design of screw insertion mainly depends on manual evaluation, and it does not have the ability to plan or verify based on a combination of physical condition and kinematics. One of the main factors that affects accuracy during surgery is the lateral sliding of the locating pin, which is often considered a significant problem and typically occurs at the facet of the herringbone groove.

Therefore, the positioning of the guidance rail could be affected by an incorrect entry point caused by the lateral sliding of the locating pin, resulting in deviation from the planned path. Additionally, minor changes in body position due to surgeon’s manipulation and patient’s respiratory motion, especially at the thoracic and lumbar vertebra, can also have an impact on the accuracy of the robot’s position.

Another concern in spine surgery is the radiation exposure that occurs during intraoperative fluoroscopy, which can be particularly problematic for surgeons and other staff involved in minimally invasive procedures. Surgical robots are designed to minimize the need for intraoperative radiation, which is one of their advantages.

Currently, robot-assisted surgery has not demonstrated a clear advantage in minimizing radiation exposure. Our doctors’ confidence and experience are the main factors that determine radiation exposure.

Need for Further Research on Postoperative Complications and Cost-Effectiveness of Robot-Assisted Surgery

When a new surgical technique is introduced and advocated, it is essential to assess not only its impact on surgical outcomes but also its effects on postoperative recovery, complications, social factors, and other relevant factors. The use of robotic technology for pedicle screw placement can potentially reduce the risk of adjacent-segment destruction, a common complication in spine surgery, by avoiding the need for surgeons to invade proximal facet joints.

Maybe due to the fact that spine surgery robots are still in the development phase, patients may have to pay more to undergo robot-assisted surgery. As a result, it may be perceived as a costly or a lucrative business tool.

The potential future application of spine surgical robotics is still widely regarded as promising. It holds significant potential for application in both horizontal and vertical fields.

Spinal surgery robots seem to offer better accuracy in placing pedicle screws compared to freehand placement or placement using fluoroscopy. Once the major limitations and drawbacks of the spine surgical robots are addressed and improved, their use is expected to become widespread in clinical practice.

If you are interested in knowing more about Spine Surgical Robotics you have come to the right place!

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
Dave
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
Eclectic54
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.