Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study.
Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study.
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DOI：
10.1007/s00586-023-08019-2
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发表时间：
2023-11
期刊：
影响因子：
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通讯作者：
Fan Feng;Xiuyuan Chen;Zude Liu;Yingchao Han;Hao Chen;Quan Li;Lifeng Lao;Hongxing Shen
中科院分区：
文献类型：
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作者：
Fan Feng;Xiuyuan Chen;Zude Liu;Yingchao Han;Hao Chen;Quan Li;Lifeng Lao;Hongxing Shen
目的机器人辅助技术已逐渐应用于脊柱外科椎弓根螺钉放置。本研究旨在详细评估初级外科医生在机器人辅助脊柱手术中的学习曲线。方法从2020年12月至2022年2月，前瞻性招募了199例需要后路椎弓根螺钉固定手术治疗的患者。患者被随机分配到机器人辅助组（RA组）或传统徒手组（CF组）。在高级专家的监督下，椎弓根螺钉由两名没有经验的初级研究员放置。累积总和（CANUUM）分析进行椎弓根螺钉放置的学习曲线进行定量评估的基础上的时间的螺钉insertion.ResultsIn的，769和788椎弓根螺钉被放置在RA和CF组。与CF组相比，RA组中上胸椎区域（57 vs. 70枚螺钉）的学习持续时间较短，但下胸椎区域（62 vs. 58枚螺钉）和腰骶区域（56 vs. 48枚螺钉）的学习持续时间较长。RA组的学习曲线斜率低于CF组。RA组的螺钉准确率为89.4%，CF组为76.7%，RA组优于CF组（上级），P < 0.001。这种差异的准确性变得更广泛的畸形病例。在上胸部区域，RA组的平均放置时间为5.34 ± 1.96 min，CF组为5.52 ± 2.43 min，而在下胸部和腰骶部区域，CF组的平均放置时间在统计学上更短。结论机器人辅助技术在上胸椎区和畸形病例中有其优势，更容易和安全地插入椎弓根螺钉。机器人辅助技术允许初级外科医生的学习曲线较短，即使在早期应用阶段也表现出一贯的优异结果。
ObjectiveRobot-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.MethodsFrom 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.ResultsIn 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.ConclusionRobot-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.