Comparison Analysis of Robot-Assisted Computed Tomography Navigation System and Manual Freehand Technique in Orthopedic Surgery

Abstract

Background and Objective: At present, the robot system and CT guidance system play a significant role in minimally invasive orthopedic surgery, because it is a precise and flexible manipulator that work in confined and complex surgical environments. The robot and CT assisted operations will become increasingly important in orthopedic surgery and in residents' education. Hence, this study aimed to investigate the application value of robot system and CT guidance system in orthopedic surgery. Methods: Firstly, a predesigned questionnaire investigation was carried out in our hospital, and 12 professionals received this questionnaire. Their private opinions on robot system and CT guidance system applied in orthopedic surgery were assessed, respectively. And then, a retrospective survey was performed on the basis of 51 medical records of patients suffering from orthopedic disorders, and all the patients ever reveived orthopedic surgery, under the guidance of a robot-assisted CT navigation system, or by the freehand technique. And the detailed surgical procedures and therapeutic effect were compared between the two groups. In addition, the informed consents of patients were obtained beforehand, and this research protocol was approved by institutional review board in our hospital. Results: The robot system and CT guidance applied in orthopedic surgery has become more popular than before in recent years. In terms of questionnaire, 12 surgeons received this investigation, but the number of validated questionnaires was 11, the response rate was 91.67% (11/12). This kind of training of robot and CT assistant orthopedic surgery varied from a training program by intuitive surgical, master-apprenticeship, fellowship, and self-designed training programs. Most respondents supported the viewpoint that a professional training program and examination for the basics of robot skills were required. With respect to the comparison of detailed surgical procedures between robot-assisted CT navigation system and freehand technique, the operation time under the guidance of robot-assisted CT navigation system was shorter (189.7 ± 65.9 min vs. 298.9 ± 91.1 min, P < 0.05), the pin regulation times under the guidance of robot-assisted CT navigation system were less (1.2 ± 0.96 vs. 12.3 ± 4.28, P < 0.0001), the intraoperative fluoroscopy time under the guidance of robot-assisted CT navigation system were shorter (12.5 ± 3.69 min vs. 52.6 ± 11.1 min, P < 0.001), and the rate of good pin insertion location was higher under the guidance of robot-assisted CT navigation system were shorter (100% vs. 56.7%, P < 0.01). The incidences of postoperative complications were less among the patients who ever received CT-aided orthopedic surgery, but the complication distribution was not statiatially significant. Conclusion: The robot and CT-aided orthopedic surgery become far more popular than before, and has been accepted within a broad scope. And, the intelligent robot-assistant CT could transform the behaviour of orthopedic operations, and make them easier, faster and probably safer, whem compared with the freehand technique. In addition, the professional training still need multidisciplinary basic skills and collaboration.