Robot-assisted Surgical System Research Articles

Efficacy and safety of a neurointerventional operation robotic assistance system in cerebral angiography

BackgroundAt present, neurointerventional surgery requires angiographers to perform operations in the digital subtraction angiography (DSA) room. Ionising radiation and chronic joint damage are still unavoidable for angiographers. Therefore, we researched...

Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain.

The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. Hinotori group had significantly longer operative and console times (p=0.030 and p=0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p=0.062). The docking-free design may contribute to reducing postoperative pain.

Robotic surgery in the treatment of oropharyngeal cancer: a case report

Background. The incidence of HpV-associated oropharyngeal squamous cell carcinoma (oscc) is steadily increasing. given the better prognosis in patients with HpV-positive cancer compared to HpV-negative cancer, attempts were made to reduce the therapeutic effect in patients with early-stage oscc to improve the quality of life of these patients. early-stage oscc can currently been treated with radiation therapy or surgery used alone or in combination. Currently, the concept of transoral surgery includes both transoral laser microsurgery and robot-assisted surgeries (da Vinci, medrobotics Flex system). Case description. We report a case of using the da Vinci robot-assisted system in the combined modality treatment of oropharyngeal cancer. The patient underwent surgery followed by chemoradiotherapy. At a follow-up of 10 months, no evidence of disease progression was found. The patient experienced no any pain on swallowing.Conclusion. The use of the da Vinci robot-assisted surgical system in the combined modality treatment of oropharyngeal cancer, especially in such a hard-to-reach area as the root of the tongue, makes it possible to better visualize and determine the boundaries of the lesion, followed by en block resection, as well as to improve functional and aesthetic results. However, careful selection of patients for this type of treatment is necessary.

Robotic arm-assisted total hip arthroplasty for preoperative planning and intraoperative decision-making

AimsThis article aimed to explore the efficacy of robotic arm-assisted total hip arthroplasty (THA) in improving preoperative planning and intraoperative decision-making.MethodsIn this single-center, prospective, randomized clinical controlled trial, 60 patients were randomly divided into two groups: conventional THA (cTHA) and robotic arm-assisted THA (rTHA). The rTHA underwent procedures using a robot-assisted surgical system, which generated three-dimensional models to determine the most appropriate prosthesis size and position. The standard process of replacement was executed in cTHA planned preoperatively via X-ray by experienced surgeons. Differences between predicted and actual prosthetic size, prosthetic position, and leg length were evaluated.ResultsSixty patients were included in the study, but one patient was not allocated due to anemia. No significant preoperative baseline data difference was found between the two groups. The actual versus predicted implantation size of both groups revealed that 27/30 (90.0%) in the rTHA group and 25/29 (86.2%) in the cTHA group experienced complete coincidence. The coincidence rate for the femoral stem was higher in the rTHA group (83.3%) than that in the cTHA group (62.7%). Between the actual and predicted rTHA, the difference in anteversion/inclination degree (< 6°) was largely dispersed, while cTHA was more evenly distributed in degree (< 9°). The differences in leg length between the surgical side and contralateral side showed a significant deviation when comparing the two groups (P = 0.003), with 0.281 (− 4.17 to 3.32) mm in rTHA and 3.79 (1.45–6.42) mm in cTHA.ConclusionRobotic arm-assisted total hip arthroplasty can be valuable for preoperative planning and intraoperative decision-making.

Robot-Assisted Radical Nephrectomy Using the Novel Avatera Robotic Surgical System: A Feasibility Study in a Porcine Model.

Purpose: To evaluate the feasibility and intraoperative technical parameters of the new robot-assisted surgical system Avatera by performing bilateral nephrectomy in a live porcine model. Materials and Methods: Six pigs underwent bilateral robot-assisted radical nephrectomy using the Avatera robotic system (RS). The operations were performed by experienced open (Group 1) and laparoscopic (Group 2) surgeons. The operating time, docking time, set-up time, and console time were evaluated. Data regarding intraoperative complications (major or not), injury of adjacent organs, and technical difficulties during the operation were also recorded. Results: Robot-assisted bilateral nephrectomy was completed effectively in all sample pigs. The docking time and set-up time were similar among the two groups, whereas the console time and operating time were significantly longer for the open surgeon group. Two intraoperative minor complications occurred in the open surgeon's group. An inadvertent damage of the renal vein occurred in two cases and the bleeding was controlled effectively. Other than the initial two cases, the estimated blood loss was <50 mL in both groups. Injury of the adjacent organs was not noticed. Conclusions: The study demonstrated that radical nephrectomy using the Avatera robotic surgical system is technically feasible, safe, and valid in pigs. Our results warrant the application of the Avatera RS in other urologic procedures, collecting data for further clinical trials.

Effect of da Vinci robot-assisted versus traditional thoracoscopic bronchial sleeve lobectomy

ObjectiveTo analyze the short-term effect of Da Vinci robot-assisted thoracoscopic (RATS) bronchial sleeve lobectomy, so as to summarize its safety and effectiveness. MethodsIt was a retrospective single-center study with the inclusion of 22 cases receiving RATS lobectomy and 49 cases of traditional thoracoscopic surgery. Further comparison was performed focusing on the baseline characteristics and perioperative performance of the two groups. ResultsCompared with the traditional thoracoscopic surgery group, RATS group had more advantages in the number of lymph nodes dissected (P = 0.003), shorter postoperative length of stay in the hospital (P = 0.040), shorter drainage time (P = 0.022), reduced drainage volume (P = 0.001). Moreover, this study found for the first time that there was a shortening in the operation of sleeve lobectomy by using Da Vinci robot-assisted surgical system (P = 0.001). The operation cost of RATS group is more expensive (96000 ± 9100.782 vs 63000 ± 5102.563 yuan; P＜0.001). ConclusionCompared with the traditional thoracoscopic bronchial sleeve lobectomy, RATS lobectomy shows advantages of higher operating sensitivity, shorter operation time, faster postoperative recovery, and more lymph nodes dissected. Collectively, RATS bronchial sleeve lobectomy is safe and effective in operation.

A New Power Law Linking the Speed to the Geometry of Tool-Tip Orientation in Teleoperation of a Robot-Assisted Surgical System

Fine manipulation is important in dexterous tasks executed via teleoperation, including in robot-assisted surgery. Discovering fundamental laws of human movement can benefit the design and control of teleoperated systems, and the training of their users. These laws are formulated as motor invariants, such as the well-studied speed-curvature power law. However, while the majority of these laws characterize translational movements, fine manipulation requires controlling the orientation of objects as well. This subject has received little attention in human motor control studies. Here, we report a new power law linking the speed to the geometry in orientation control – humans rotate their hands with an angular speed that is exponentially related to the local change in the direction of rotation. We demonstrate this law in teleoperated tasks performed by surgeons using surgical robotics research platforms. Additionally, we show that the law's parameters change slowly with the surgeons' training, and are robust within participants across task segments and repetitions. The fact that this power law is a robust motor invariant suggests that it may be an outcome of sensorimotor control. It also opens questions about the nature of this control and how it can be harnessed for better control of human-teleoperated robotic systems.

Feasibility of a Robot-Assisted Surgical Navigation System for Mandibular Distraction Osteogenesis in Hemifacial Microsomia: A Model Experiment.

This study aimed to investigate the feasibility and accuracy of osteotomy and distractor placement using a robotic navigation system in a model surgical experiment of mandibular distraction osteogenesis for hemifacial microsomia. Imaging data from 5 patients with Pruzansky-Kaban type II (IIa: 4; IIb: 1) mandibular deformities were used to print 3D models for simulated mandibular distraction osteogenesis. In the experimental group, a robot-assisted surgical navigation system was used to perform the surgery under robotic guidance following registration, according to the preoperative design. Conventional surgery was performed in the control group, in which the operation was based on intraoperative estimations of the preoperative design by experienced surgeons. The accuracies of the osteotomy and distractor placement were assessed based on distance and angular error. Osteotomy accuracy was higher in the experimental group than in the control group, and the distance error ( t =9.311, P <0.001) and angular error ( t =5.385, P =0.001) were significantly reduced. The accuracy of distractor placement was also significantly higher in the experimental group, while the distance error ( t =3.048, P =0.016) and angular error ( t =3.524, P =0.024) were significantly reduced. The present results highlight the feasibility of robot-assisted distraction osteogenesis combined with electromagnetic navigation for improved surgical precision in clinical settings.

Single-Port Transaxillary Robot-Assisted Latissimus Dorsi Muscle Flap Reconstruction for Poland Syndrome: Concomitant Application of Robotic System to Contralateral Augmentation Mammoplasty.

Currently, robot-assisted latissimus dorsi muscle flap (RLDF) surgery is used in treating patients with Poland syndrome and for breast reconstruction. However, conventional RLDF surgery has several inherent issues. We resolved the existing problems of the conventional system by introducing the da Vinci single-port system in patients with Poland syndrome. Overall, three patients underwent RLDF surgery using the da Vinci single-port system with gas insufflation. In the female patient, after performing RLDF with silicone implant, augmentation mammoplasty was also performed on the contralateral side. Both surgeries were performed as single-port robotic-assisted surgery through the transaxillary approach. The mean operating time was 449 (335–480) minutes; 8.67 (4–14) minutes were required for docking and 59 (52–67) minutes for robotic dissection and LD harvesting. No patients had perioperative complication and postoperative problems related to gas inflation. The single-port robot-assisted surgical system overcomes the drawbacks of previous robotic surgery in patients with Poland syndrome, significantly shortens the procedure time of robotic surgery, has superior cosmetic outcomes in a surgical scar, and improves the operator's convenience. Furthermore, concurrent application to another surgery demonstrates the possibility in the broad application of the robotic single-port surgical system.

Combining robot-assisted surgical system and 3D visualization system for teaching minimally invasive vitreoretinal surgery.

To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional (3D) visualization system. Enucleated porcine eyes were established as an animal model for removing foreign bodies. Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system. One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group. One senior surgeon evaluated the retinal invasion by a graded injury degree. The learning curve for minimally invasive vitreoretinal surgery was described. Compared with the robot-assisted group, the injury degree was higher in the manual group. For the first ten surgeries, the manual and robot-assisted groups had injuries of 2.60±1.35 (4 to 0) and 1.80±1.62 (4 to 0), respectively. For the last ten surgeries, the injury degrees were 1.90±1.20 (3 to 0) and 0.80±0.42 (1 to 0). Considering the manual and robot-assisted groups together, 95%, 75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable, easier and clearer, respectively. The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.

ADRC-Based Control Method for the Vascular Intervention Master-Slave Surgical Robotic System.

In vascular interventional surgery, surgeons operate guidewires and catheters to diagnose and treat patients with the assistance of the digital subtraction angiography (DSA). Therefore, the surgeon will be exposed to X-rays for extended periods. To protect the surgeon, the development of a robot-assisted surgical system is of great significance. The displacement tracking accuracy is the most important issue to be considered in the development of the system. In this study, the active disturbance rejection control (ADRC) method is applied to guarantee displacement tracking accuracy. First, the core contents of the proportional–integral–derivative (PID) and ADRC methods are analyzed. Second, comparative evaluation experiments for incremental PID and ADRC methods are presented. The results show that the ADRC method has better performance of than that of the incremental PID method. Finally, the calibration experiments for the ADRC control method are implemented using the master–slave robotic system. These experiments demonstrate that the maximum tracking error is 0.87 mm using the ADRC method, effectively guaranteeing surgical safety.

The concept of spatial motion restriction zones in a robot-assisted surgical system.

The development of robotics and medicine in recent years leads to increasing mutual integration of these two disciplines. The use of specialized robotic solutions in medicine poses new challenges, including the issue of safety. The paper analyzes existing solutions aimed at improving safety in medical robotics. The concept of spatial motion restriction zones-areas of space affecting the process of robot-assisted surgery and designed to minimize risks for the patient is proposed. Various applications of such zones are considered, such as: creating an optimal medical tool path when planning an operation, an adaptive movement restriction during manual manipulator control, including limiting maximum velocity. An approach to adaptively changing the parameters of motion restriction zones is presented, and possible data sources for this change are considered. A technique is introduced for using a hybrid motion restriction zone, combining several zones into a single complex system with various types of interaction. Approaches to manual control of a collaborative robot, including the use of force-torque sensors, are considered.

11 Results from the first-in-human clinical trial of a new robot-assisted surgical system for total laparoscopic hysterectomy

11 Results from the first-in-human clinical trial of a new robot-assisted surgical system for total laparoscopic hysterectomy

Preclinical evaluation of the versius surgical system, a new robot-assisted surgical device for use in minimal access general and colorectal procedures

ObjectiveTo evaluate the utility of a new robot-assisted surgical system (the Versius Surgical System, CMR Surgical, Cambridge, UK) for use in minimal access general and colorectal surgery, in a preclinical setting.Summary background dataRobot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is designed to assist surgeons in performing minimal access surgery and overcome some of the challenges associated with currently available surgical robots.MethodsCadaveric sessions were conducted to evaluate the ability of the system to provide adequate surgical access and reach required to complete a range of general and colorectal procedures. Port and bedside unit positions were recorded, and surgical access and reach were evaluated by the lead surgeon using a visual analogue scale. A live animal (porcine) model was used to assess the surgical device’s safety in performing cholecystectomy or small bowel enterotomy.ResultsNine types of procedure were performed in cadavers by nine lead surgeons; 35/38 procedures were completed successfully. The positioning of ports and bedside units reflected the lead surgeons’ preferred laparoscopic set-up and enabled good surgical access and reach. Cholecystectomy (n = 6) and small bowel enterotomy (n = 5) procedures performed in pigs were all completed successfully by two surgeons. There were no device-related intra-operative complications.ConclusionsThis preclinical study of a new robot-assisted surgical system for minimal access general and colorectal surgery demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. In particular, the provision of stable magnified three-dimensional vision, tremor filtering, motion scaling, and articulated instruments with robot-assisted surgery has the potential to enable more surgeons to perform more complex surgery compared with conventional laparoscopy. The aim of this study was to evaluate the utility of a new robot-assisted surgical system (Versius, CMR Surgical, Cambridge, UK) for gynecologic procedures in a preclinical setting. Cadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a robot-assisted total laparoscopy hysterectomy. A live animal (porcine) model was used to assess the system in performing oviduct removal as a surrogate for robot-assisted total laparoscopy hysterectomy. Procedures were performed by experienced gynecologic surgeons, supported by a surgical team. The precise surgical steps conducted to conclude that the procedures could be fully completed were systematically recorded, as well as instruments used and endoscope angle. In total, six gynecologic procedures were performed in cadavers by four surgeons; 16/17 procedures were completed successfully. Positioning of the ports and bedside units reflected the surgeons’ preferred laparoscopic setup and enabled good surgical access and reach, as exemplified by the high procedure completion rate. Oviduct removal procedures performed in pigs were all completed successfully by a single surgeon. This preclinical study of a new robot-assisted surgical system for gynecologic procedures demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.

Preclinical Evaluation of the Versius Surgical System, a New Robot-assisted Surgical Device for Use in Minimal Access Renal and Prostate Surgery

BackgroundMinimal access surgery (MAS) is well-established in urological surgery. However, MAS is technically demanding and associated with a prolonged learning curve. Robot-assisted laparoscopy has made progress in overcoming these challenges. ObjectiveThe aim of this study was to evaluate the feasibility of a new robot-assisted surgical system (the Versius Surgical System; CMR Surgical, Cambridge, UK) for renal and prostate procedures in a preclinical setting, at the IDEAL-D phase 0. Design, setting, and participantsCadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a radical nephrectomy, prostatectomy, and pelvic lymph node dissection. A live animal (porcine) model was also used to assess the surgical device in performing radical nephrectomy safely and effectively. Procedures were performed by experienced renal and prostate surgeons, supported by a full operating room team. Outcome measurements and statistical analysisSurgical access and reach were evaluated by the lead surgeon using a visual analogue scale. The precise surgical steps conducted to make the assessment that the procedures could be completed fully were recorded, as well as instruments used (including manual laparoscopic instruments) and endoscope angle. Results and limitationsIn total, all 24 procedures were completed successfully in cadavers by eight different lead surgeons. Positioning of the ports and bedside units reflected the lead surgeon’s preferred laparoscopic set-up and enabled good surgical access and reach, as quantified by a median visual analogue score of ≥6.5. Radical nephrectomies performed in pigs were all completed successfully, with no device- or non–device-related intraoperative complications recorded. Testing in human cadavers and pig models balances the bias introduced by each model; however, it is impossible to completely replicate the experience and performance of the robot for surgery in live humans. ConclusionsThis is the first preclinical assessment of the Versius Surgical System for renal and prostate procedures. The safety and effectiveness of the system have been demonstrated and warrant progressive assessment in a clinical setting utilising the IDEAL-D framework. Patient summaryIn this report, we looked at the usability of a new robot-assisted surgical device for renal and prostate surgery by testing the system in cadavers and pigs. We found that a number of different surgeons and operating team personnel were able to use the system to successfully complete the procedures under evaluation. We conclude that the system is ready to be tested in live human studies.

43: First-in-human clinical trial of a new robot-assisted surgical system for total laparoscopic hysterectomy

Versius is a new tele-operated robotic surgical system designed to assist surgeons in performing minimal access surgery (MAS). Versius has been developed broadly in line with recommendations from the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) collaboration for surgical research.1,2 Versius is currently undergoing a first-in-human clinical study to confirm the safety and effectiveness of the device when performing MAS procedures. The aim of this study was to perform an interim analysis to confirm the safety of the device when performing total laparoscopic hysterectomy (TLH) procedures (aligned with IDEAL Stage 2a). This is an interim analysis of an ongoing prospective, cohort, clinical study designed to confirm the safety of Versius when performing minor or intermediate surgical procedures. All potentially eligible patients were identified from hospital surgical lists and approached directly by their surgeon or existing clinical team. Subjects provided consent before the start of surgery and the study was reviewed and approved by the Institutional Ethics Committee (DGCI registration No. ECR/15/Inst/Maha/2013/RR-16). All surgeons completed and passed the validated 3.5-day Versius training program immediately prior to the start of the study. Patients completed a pre-operative screening visit prior to surgery and were followed up on post-operative Day 30 (+/- 7 days) and Day 90 (+/- 7 days). Procedures were completed at the Deenanath Mangeshkar Hospital and Research Center, Erandawne, Pune, Maharashtra, India. The first 15 TLH procedures performed using Versius have been included for analysis (Table 1). One procedure was converted to open surgery due to the patient’s raised body mass index (BMI); all other procedures were completed as planned and without recorded complication. Surgical indications included adenomyosis, abnormal uterine bleeding, uterine fibrosis, endometriosis and menorrhagia. Patients were aged 28–51 years (median: 40 years) and represented a wide range of BMIs, 21.8–47.8 kg/m2 (median: 26.3 kg/m2). Operating time ranged between 110–345 mins (median: 205 mins) and all patients had an estimated blood loss <500 mL. Median stay in hospital was 4 days (range: 3–7 days). No adverse events were reported at the 30-day follow-up. Surgeons and surgical teams were able to successfully complete robot-assisted TLH using the Versius system without experiencing any device-related difficulties. The first-in-human cases presented here justify continued patient recruitment onto the Versius clinical trial and progression to major procedures. Additional recruitment and analysis will ensure continued alignment with the IDEAL Framework Stage 2b.1

Research on the accuracy of three-dimensional localization and navigation in robot-assisted spine surgery.

Compared with traditional surgical methods, which only rely on doctors' experience, three-dimensional robot-assisted navigation technology could locate the lesion more accurately. The transformation principle of three-dimensional navigation system was analyzed. The surgical path was planned on the reconstructed three-dimensional model. The experimental data of positioning position and posture were used as two important parameters to evaluate the accuracy of the robot-assisted spine surgery navigation system. The final experimental results show that the accuracy of the positioning and navigation position of the robot-assisted surgical navigation system was 2.54 ± 0.15mm (range 2.25-2.76 mm). The accuracy of positioning and navigation posture was 2.55 ° ± 0.49°(range 1.92°-3.21°). It could be seen the three-dimensional positioning and navigation system proposed in this study had a high accuracy and could basically meet the basic accuracy requirements of spine surgery.

Learning curve of robot-assisted middle pancreatectomy (RMP): experience of the first 100 cases from a high-volume pancreatic center in China.

Middle pancreatectomy (MP) is safe and feasible in patients with benign or low-grade malignant tumors located at the neck or proximal body of the pancreas. As a tissue-sparing operation, MP can preserve normal pancreatic function and reduce the risk of postoperative endocrine and exocrine insufficiency. However, the morbidity, especially the postoperative pancreatic fistula (POPF) rate, remains high. A robot-assisted surgical system may provide patients with less trauma; however, there are few reports on robot-assisted middle pancreatectomy (RMP). We describe the experience of RMP at our center to illustrate the learning curve (LC). From August 2010 to July 2017, 100 patients underwent RMP in the Pancreatic Disease Center of Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. Patient characteristics, operative outcomes, and oncological outcomes were collected and analyzed. The CUSUM curve was analyzed according to operative time and estimated blood loss (EBL) and was used to describe the LC and identify the flexion points. Among the 100 patients who underwent RMP in our hospital, the mean age was 47.5 ± 14.2years, and 69 patients were female. From the CUSUM curve, we found two flexion points: cases 12 and 44. After 44 cases, the rate of improvement was much faster. We separated the patients into two groups based on the LC (cases 1-44 and cases 45-100). There were significant improvements in operative time (173.1 ± 44.7min vs. 137.3 ± 30.1min, p < 0.001) and EBL (103.4 ± 90.0ml vs. 69.3 ± 53.9ml, p = 0.021). The overall POPF rate was 32% (32/100), while the incidence rate of biochemical leakage was 14% (14/100). However, there was no significant difference in the risk of POPF or other complications between the two groups. The postoperative length of stay (LOS) was also not different. The 90-day mortality rate was 1%. From our long-term follow-up, pancreatic function was preserved in most patients, with only three cases of endocrine insufficiency and two cases of exocrine insufficiency. RMP was helpful and a good choice for the selected patients. PF was the main complication and has not been improved until now. There were two flexion points in the LC at cases 12 and 44. More cases are needed to gain more experience. A larger sample size and prospective studies are needed to verify the advantage of RMP.

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study.

BackgroundWith the in-depth development of minimally invasive spine surgery in recent years, robot- and computer-assisted technologies have been increasingly used and successfully applied to spinal surgery.Material/MethodsWe performed a retrospective analysis of 60 patients with grade I or II lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from January 2017 to December 2017. A robot-assisted surgical system was used in 30 patients for pedicle screw placement. The other 30 patients underwent fluoroscopy-guided percutaneous pedicle screw placement.ResultsThere were 130 screws placed under fluoroscopic guidance, with 26.2% penetration of the pedicle wall. There were 130 screws placed in robotic-assisted surgery, with 6.2% penetration of the pedicle wall. Severe screw deviation (Neo grade III) was identified in 4 screws in the fluoroscopy-guided group, while no severe deviation was noted in the robot-assisted group. In the fluoroscopic group, 15.6% of screws penetrated the superior articular process, and 2.1% screws had severe complications (Babu grade III). However, only 5.1% of screws in the robot-assisted group had severe complications. The mean screw insertion angle was significantly greater in the robot-assisted group than in the fluoroscopy-guided group (23.8±6.1° vs. 18.4±7.2°, P=0.017).ConclusionsCompared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the following advantages: greater accuracy, lower incidences of screw penetration of the pedicle wall and invasion of the facet joints, and better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.