Robot-assisted Surgical Systems Research Articles

Comparative Analysis of da Vinci® Xi and hinotori™ SRS Robot-Assisted Surgery Systems for Gynecologic Disorders: A Retrospective Study.

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 benign uterine tumors; 88 pelvic organ prolapses; 270 low-risk endometrial cancers) of robot-assisted surgery performed at Kagoshima University Hospital between January 2017 and October 2024. Surgical factors such as the operative time, blood loss, and complication rates were analyzed and compared between the da Vinci® Xi (332 cases) and hinotori™ SRS (69 cases) systems. Complications were classified according to the Clavien-Dindo classification, with Grade 2 or higher considered significant. Results: Significant differences were observed between the two groups in terms of age, body mass index, cockpit/console time, and median time from roll-in to cockpit/console start. The cockpit/console time was significantly longer for the hinotori™ SRS system (173 min) compared to the da Vinci® Xi (156 min; p = 0.047). No significant differences were observed in the total operative time, blood loss, or length of hospital stay. Intraoperative complications were minimal, with one case of bladder injury and one case of vascular injury recorded for the da Vinci® Xi. The overall postoperative complication rate was approximately 4%. Conclusions: Robot-assisted surgery using both the da Vinci® Xi and hinotori™ SRS systems was found to be safe, with minimal blood loss and a low complication rate. The hinotori™ SRS system demonstrated operative outcomes comparable to those of the da Vinci Xi® system, suggesting that it may serve as a viable alternative. Further prospective studies are warranted to evaluate the efficacy and safety of these systems.

The Integration of Robotics in Surgery: Advancements, Challenges, and Future Prospects

The integration of robotics in surgery marks a transformative advancement in modern medicine, offering unprecedented precision, control, and minimally invasive options. This paper explores the evolution of robotic-assisted surgical systems, from early prototypes to sophisticated platforms like the da Vinci Surgical System, which have redefined operative procedures across multiple specialties. By analyzing key advancements, including enhanced visualization, precise articulation, and AI-assisted decision-making, this study highlights how robotics improves surgical outcomes, reduces recovery times, and minimizes complications. Despite these benefits, the adoption of surgical robotics faces challenges, including high costs, steep learning curves for surgeons, and regulatory hurdles. Additionally, the ethical implications of robotic autonomy in critical medical procedures prompt ongoing debate. This paper also examines the future prospects of robotics in surgery, such as AI-driven diagnostics, remote surgeries, and potential full automation. Through a comprehensive review, this study seeks to provide a nuanced understanding of the impact of robotics on surgical practice and healthcare outcomes, offering insights into both the potential and limitations of robotic integration in surgery.

Interpretation of the 2023 version of the international consensus guidelines for robotic pancreatic surgery

With the continuous advancement of robot-assisted surgical system and the continuous accumulation of clinical experience of surgeons, robot-assisted surgical systems are becoming more and more widely used in the field of pancreatic surgery. Several studies have suggested that robot-assisted pancreatic surgery has significant advantages over traditional pancreatic surgery. The "International consensus guidelines on robotic pancreatic surgery in 2023" provides more standardized guidance on the applicability and safety of robotic-assisted pancreatic surgery, and discusses in detail the indications, safety, learning curve, and related issues of robot-assisted pancreaticoduodenectomy, distal pancreatectomy,and mid pancreatectomy. In addition, the application value of robot-assisted surgical systems in special patients was discussed, as well as the new technology of robot-assisted pancreaticointestinal anastomosis and the new concept of pancreatic duct repair surgery. This article interprets the guidelines based on the recommendations of the guidelines and the practical experience of the authors' team in the field of robotic-assisted pancreatic surgery.

Strategies to build a robotic liver surgery program

Over the past few decades, an increasing proportion of abdominal surgeries are performed through minimally invasive platforms. In contrast, adaptation of minimally invasive techniques for liver surgery has garnered slower attraction due to the complexity and associated morbidity and mortality with these operations. Compared to laparoscopy, the robotic-assisted surgical system provides a three-dimensional operative view and instruments with articulation that mimic and extend wrist movement. These elements improve operative dexterity making dissection and suturing easier. Additionally, robotic surgery improves operative ergonomics and decreases physical and mental fatigue. Studies show that the robotic platform is safe and versatile with many technical advantages for complex operations, improved short-term outcomes compared to open surgery, and comparable oncologic outcomes. As such, hepatobiliary surgeons are increasingly adapting robotic techniques in their practice. It is crucial that as more hospitals adopt this technology, patient safety monitoring and quality initiatives are maintained. Establishing a robotic liver surgery program revolves around three pillars: designing a curriculum to overcome the learning curve, building a strong clinical and administrative team, and appropriate patient selection.

Heart rate variability as a predictor of intraoperative autonomic nervous system homeostasis

The aim of the proof-of-concept study is to investigate the level of concordance between the heart rate variability (HRV), the EEG-based Narcotrend Index as a surrogate marker for the depth of hypnosis, and the minimal alveolar concentration (MAC) of the inhalation anesthetic sevoflurane across the entire course of a surgical procedure. This non-blinded cross-sectional study recorded intraoperative HRV, Narcotrend Index, and MAC in 31 male patients during radical prostatectomy using the Da-Vinci robotic-assisted surgical system at Mannheim University Medical Center. The degree of concordance was calculated using repeated measures correlation with the R package (rmcorr) and presented using the rmcorr coefficient (rrm). The Narcotrend Index correlates significantly across all measures with the time-dependent parameter of HRV, the standard deviation of the means of RR intervals (SDNN) (rrm = 0.2; p < 0.001), the frequency-dependent parameters low frequency (LF) (rrm = 0.09; p = 0.04) and the low frequency/high frequency ratio (LF/HF ratio) (rrm = 0.11; p = 0.002). MAC correlated significantly negatively with the time-dependent parameter of heart rate variability, SDNN (rrm = -0.28; p < 0.001), the frequency-dependent parameter LF (rrm = -0.06; p < 0.001) and the LF/HF ratio (rrm = -0.18; p < 0.001) and the Narcotrend Index (rrm = -0.49; p < 0.001) across all measures. HRV mirrors the trend of the Narcotrend Index used to monitor depth of hypnosis and the inhibitory influence of the anesthetic sevoflurane on the autonomic nervous system. Therefore, HRV can provide essential information about the homeostasis of the autonomic nervous system during general anesthesia. DRKS00024696, March 9th, 2021.

Robotic Assistance and Haptic Feedback in Arthroscopic Procedures: Design and Preliminary Evaluation of a Two-Arm System

Robot-assisted arthroscopic surgery has been receiving growing attention in the field of orthopedic surgery. Most of the existing robot-assisted surgical systems in orthopedics place more focus on open surgery than minimally invasive surgery (MIS). In traditional arthroscopic surgery, the surgeon needs to hold an arthroscope with one hand while performing the surgical operations with the other hand, which can restrict the dexterity of the surgical performance and increase the cognitive load. On the other hand, the surgeon heavily relies on the arthroscope view when conducting the surgery, whereas the arthroscope view is a largely localized view and lacks depth information. To assist the surgeon in both scenarios, in this work, we develop a two-arm robotic system. The left-arm robot is used as a robot-assisted arthroscope holder, and it can hold the arthroscope still at a designated pose and reject all other potential disturbances, while also allowing the operator to move it via a pedal switch whenever needed. The left-arm robot is implemented with an impedance controller and a gravity iterative learning (Git) scheme, where the former can provide compliant robot behavior, thus ensuring a safe human–robot interaction, while the latter can accurately learn for gravity compensation. The right-arm robot is used as a robot-assisted surgical tool, providing virtual fixture (VF) assistance and haptic feedback during the surgery. The right-arm robot is implemented with a point-based VF algorithm, which can generate VF directly from point clouds in any shape, render force feedback, and deliver it to the operator. Furthermore, the VF, the bone, and the surgical tool position are visualized in a 3D digital environment as additional visual feedback for the operator. A series of experiments are conducted to evaluate the effectiveness of the prototype. The results demonstrate that both arms can provide satisfactory assistance as designed.

A trans-umbilical single-site plus one robotic-assisted surgery for choledochal cyst resection in children.

The purpose of this study is to compare the intraoperative and postoperative outcomes of a trans-umbilical single-site plus one robot-assisted surgery and a trans-umbilical single-site laparoscopic surgery in the treatment of choledochal cysts. We retrospectively analyzed clinical data from 49 children diagnosed with choledochal cysts who were admitted to our hospital between June 2020 and December 2023. Among these patients, 24 underwent a trans-umbilical single-site plus one Da Vinci robot-assisted surgery (the robot group) and 25 underwent a trans-umbilical single-site laparoscopic-assisted surgery (the laparoscopic group). We compared differences in intraoperative and postoperative outcomes between the two groups. There was no significant difference between the two groups of patients in terms of gender, age, weight, clinical symptoms, maximum cyst diameter, type, postoperative complications, and facial expression, leg movement, activity, crying, and comfortability (FLACC) scoring (p > 0.05). Compared with the patients in the laparoscopic group, those in the robot group had less intraoperative bleeding [10 (8-12) vs. 15 (11.5-18) ml, p < 0.001] and required less postoperative drainage tube indwelling time [5 (4-6) vs. 7 (5.5-8) day, p < 0.001], less postoperative fasting time [4 (3-4) vs. 6 (5-7) days, p < 0.001], and less postoperative hospitalization time [6 (6-7) vs. 8 (6-10) days, p < 0.001], but they required more operative time [385.5 (317.0-413.3) vs. 346.0 (287.0-376.5) min, p = 0.050] and consumed more hospitalization expenses (79,323 ± 3,124 vs. 31,121 ± 2,918 yuan, p < 0.001). The results of this study showed a shorter hospitalization time, quicker postoperative recovery, and less tissue damage but a higher cost and a longer operation time in patients who chose robotic surgery rather than laparoscopic surgery. With the continuous expansion of the scale of installed robot-assisted surgical systems and the gradual accumulation of the technical experience of surgeons, robot-assisted surgery may slowly surpass, and shows a trend to replace, laparoscopy because of its advantages.

Modeling, Analysis and Evaluation of a Novel Compact 6-DoF 3-RRRS Needle Biopsy Robot

Robot-assisted surgical systems have been widely applied for minimally invasive needle biopsies thanks to their excellent accuracy and superior stability compared to manual surgical operations, which lead to possible fatigue and misoperation due to long procedures. Current needle biopsy robots are normally customed designed for specific application scenarios, and only position-level kinematics are derived, preventing advanced speed control or singularity analysis. As a step forward, this paper aims to design a universal needle biopsy robot platform which features 6 DoF 3-RRRS (Revolute–Revolute–Revolute–Spherical) parallel structure. The analytical solutions to its nonlinear kinematic problems, including forward kinematics, inverse kinematics, and differential kinematics are derived, allowing fast and accurate feedback control calculations. A multibody simulation platform and a first-generation prototype are established next to provide comprehensive verifications for the derived robotic model. Finally, simulated puncture experiments are carried out to illustrate the effectiveness of the proposed method.

Assessing the Robot-Assisted Surgical Systems between Developed and Developing Economies

Robot-assisted surgery (RAS) is a revolutionary technology for the surgeons, doctors and physicians. Although RAS deployment is rapid since 2019, despite decades of successful robotic assisted surgeries in the developed economies that have positively impacted millions of patients, RAS was barely explored by the developing countries compared to the developed countries whereby capabilities to enhance and improve the levels of expertise is limited besides acquisition and operating costs. This paper aims to raise awareness and compare what is the future of RAS in selected developing countries given its multitude of needs and challenges? Is RAS still in early days and too expensive to be put to general use in these developing economies today? We applied indicators to test the adoption of RAS using the economic consideration of robotic surgery in health economics. We examine the likelihood of acquiring and using RAS with different market characteristics from 2000 to 2022. We used data on traditional and robot-assisted surgical interventions and transform it into an improved version on Quality-Adjusted Life Year (QALY) and Willingness-to-Pay for Robot-Assisted Surgery (WTPR). Asia growth was spectacular. China’s participation resulted in closing the gap much faster in advanced medical technology and treatment such as RAS between developing and developed economies beside knowledge diffusion. South Koreans had catch up with the Europeans i.e., Italy, Germany, France and UK. China’s total patents had explosive growth and the robot density was among the highest among the selected economies compared in this study.

Robotic assisted orbital surgery for resection of advanced periocular tumours – a case series report on the feasibility, safety and outcome

PurposeOrbital surgery benefits from well-designed instrumentation that offers gentle tissue manipulation, high manoeuvrability and control. Nevertheless, in confined spaces, tissue manipulation must be accomplished with exceptionally high accuracy and precision. This is where robotic surgery offers an advantage. We aimed to evaluate a robotic-assisted surgical system’s feasibility, safety and outcome in assisting tumour clearance.Patients and methodsA case series of patients with advanced periocular tumours undergoing robotic-assisted globe-sparing resection was performed using the DaVinci XI system (Intuitive Surgical, Inc). Institutional ethics and multidisciplinary approval were sought in all cases.ResultsFour patients with advanced periocular tumours underwent robotic-assisted orbital surgery at a mean age of 63 years (range 42–86). Two patients were diagnosed with squamous cell carcinoma, and two had basal cell carcinoma. One patient was found to have positive lymph nodes at the time of surgery and underwent simultaneous parotidectomy and lymph node clearance. Clear resection of the primary tumour was achieved in all patients; three patients underwent further resection due to narrow margins prior to reconstruction. Patients were follow-up for at least one year, and three remained disease-free. One patient with pre-existing extra-orbital disease developed metastatic disease four months post-op. All patients preserved vision peri-operatively, with no complaints of diplopia. Moderate ocular surface disease was noted in two patients.ConclusionOur series highlights the potential advantage of three-dimensional optics, multi-directional instrumentation and motion scaling technology to achieve globe-sparing tumour resection in advanced periocular tumours. However, further robotic instrumentation development is required for orbital surgery.

A lightweight segmentation network for endoscopic surgical instruments based on edge refinement and efficient self-attention.

In robot-assisted surgical systems, surgical instrument segmentation is a critical task that provides important information for surgeons to make informed decisions and ensure surgical safety. However, current mainstream models often lack precise segmentation edges and suffer from an excess of parameters, rendering their deployment challenging. To address these issues, this article proposes a lightweight semantic segmentation model based on edge refinement and efficient self-attention. The proposed model utilizes a lightweight densely connected network for feature extraction, which is able to extract high-quality semantic information with fewer parameters. The decoder combines a feature pyramid module with an efficient criss-cross self-attention module. This fusion integrates multi-scale data, strengthens focus on surgical instrument details, and enhances edge segmentation accuracy. To train and evaluate the proposed model, the authors developed a private dataset of endoscopic surgical instruments. It containing 1,406 images for training, 469 images for validation and 469 images for testing. The proposed model performs well on this dataset with only 466 K parameters, achieving a mean Intersection over Union (mIoU) of 97.11%. In addition, the model was trained on public datasets Kvasir-instrument and Endovis2017. Excellent results of 93.24% and 95.83% were achieved on the indicator mIoU, respectively. The superiority and effectiveness of the method are proved. Experimental results show that the proposed model has lower parameters and higher accuracy than other state-of-the-art models. The proposed model thus lays the foundation for further research in the field of surgical instrument segmentation.

Application of tactile sensing in human-computer interaction in robot-assisted surgery and medical fields

Robot-assisted Minimally Invasive Surgery (RMIS) is a revolutionary breakthrough in the field of surgery in 21st-century clinical medicine, and in recent years it has become the standard of care in Western medicine. It makes highly accurate medical operations possible based on the advantages of traditional minimally invasive surgery, such as reducing patient trauma and accelerating post-operative healing. However, the most advanced robotic-assisted surgical systems available on the market, as exemplified by the da Vinci system, are still not equipped with tactile receptors. In recent years, scientists and engineers have come up with different techniques and ideas, including various forms of tactile sensors, to improve the quality of the process. In this paper, the sensor devices that can be used for RMIS are classified into six different types based on their structural characteristics, and typical examples of them are listed. For some of the sensing structures that are only in the theoretical stage, inferences and explanations are given based on references. And the application directions are summarized as tactile diagnosis and operator sensing. Research in the last decade in both areas of sensing technology is summarized and outlined respectively.

Efficacy of the newly designed "SkyWalker" robot compared to the MAKO robotic system in primary total knee arthroplasty: a one-year follow-up study.

Robot-assisted surgical systems for performing total knee arthroplasty (TKA) have gained significant attention. This study was designed to compare the surgical outcomes in primary TKA surgery between the recently developed "SkyWalker" robot system and the more commonly used MAKO robot. A total of 75 patients undergoing primary TKA surgery by the same surgical team were included in this study, with 30 patients in the "SkyWalker" group and 45 patients in the "MAKO" group. We documented the osteotomy plan for both robotic systems. The lower limb alignment angles were evaluated by postoperative radiographic assessment. The operation time, estimated blood loss, postoperative hospital stays, and changes in laboratory indexes were collected during hospitalization. In addition, a comparative evaluation of knee functional assessments and complications was conducted during sixmonth and oneyear follow-ups. There were no significant differences between the two groups in terms of the accuracy of restoring lower limb alignment, estimated blood loss, or operation time. The knee function assessments at six months and one year postoperatively were similar in both groups. Except for day three after surgery, the level of interleukin-6 (IL-6) and the change in IL-6 (∆IL-6) from preoperative baseline were higher in the "SkyWalker" group than in the MAKO group (median: 20.53 vs. 14.17, P=0.050 and median: 17.30 vs. 10.09, P=0.042, respectively). Additionally, one patient from the MAKO group underwent revision surgery at nine months postoperatively due to ongoing periprosthetic discomfort. The newly developed "SkyWalker" robot showed comparable efficacy to the MAKO robot in terms of lower limb alignment accuracy and postoperative sixmonth and oneyear follow-up of clinically assessed resumption of knee function.

Adaptive Human-Robotic Interaction for Robotic-assisted Surgical Settings.

Increased complexity in robotic-assisted surgical system interfaces introduces problems with human-robot collaboration that result in excessive mental workload (MWL), adversely impacting a surgeon's task performance and increasing error probability. Real-time monitoring of the operator's MWL will aid in identifying when and how interventions can be best provided to moderate MWL. In this study, an MWL-based adaptive automation system is constructed and evaluated for its effectiveness during robotic-assisted surgery. This study recruited 10 participants firstto perform surgical tasks under different cognitive workload levels. Physiological signals were obtained and employed to build a real-time system for cognitive workload monitoring. To evaluate the effectiveness of the proposed system, 15 participants were recruited to perform the surgical task with and without the proposed system. The participants' task performance and perceived workload were collected and compared. The proposed neural network model achieved an accuracy of 77.9% in cognitive workload classification. In addition, better task performance and lower perceived workload were observed when participants completed the experimental task under the task condition supplemented with adaptive aiding using the proposed system. The proposed MWL monitoring system successfully diminished the perceived workload of participants and increased their task performance under high-stress conditions via interventions by a semi-autonomous suction tool. The preliminary results from the comparative study show the potential impact of automated adaptive aiding systems in enhancing surgical task performance via cognitive workload-triggered interventions in robotic-assisted surgery.

Tracing the evolution of robotic-assisted total knee arthroplasty: a bibliometric analysis of the top 100 highly cited articles.

Robotic-assisted surgical systems hold promise in enhancing total knee arthroplasty (TKA) outcomes and patients' quality of life. This study aims to comprehensively analyze the literature on robot-assisted total knee arthroplasty (r-TKA), providing insights into its current development, clinical application, and research trends. A systematic search was conducted in the Web of Science Core Collection (WOSCC) to identify relevant articles. Data were collected from the top 100 highly cited articles. Article evidence levels were assessed following established guidelines. Statistical analyses and visualizations were performed to reveal publication trends, citations, research hotspots, and collaborative networks. The analysis covered 100 highly cited articles meeting the research criteria, with a focus on the last five years. The United States emerged as a major contributor, with most publications and citations in the Journal of Knee Surgery and Knee Surgery Sports Traumatology Arthroscopy. Research priorities revolved around clinical outcomes, accuracy, and alignment of r-TKA. Notably, higher evidence levels correlated with more citations, indicating greater attention. Interest in and research on r-TKA is steadily increasing, with a few countries at the forefront of these endeavors. While numerous studies have already reported short- to medium-term follow-up results, it is crucial to conduct longer-term investigations to gain a more comprehensive understanding of the clinical benefits that r-TKA offers compared to conventional techniques. Through ongoing research and a greater embrace of robotic technology, we can continue to improve the quality of life for patients undergoing knee arthroplasty.

A data driven recurrent neural network approach for reproduction of variable visuo-haptic force feedback in surgical tool insertion

The surge of interest in haptic technology is due to inspirational advances in the robotic-assisted surgical system, where haptics has the role of delivering tactile feedback for enhancement of user experience. This work presents a Long Short Term Memory (LSTM) based Recurrent Neural Network (RNN) framework with Dimensionality Reduction (DR) and a Cyclical Learning Rate (CLR) optimizer for reproducing variable forces produced in different skin layers during the performance of various surgical procedures. This paper deals with online estimation of the force parameters of original porcine skin, and the same has been tested in real-time and Visuo-haptic environment for training surgeons. The proposed model has processed both spatial and temporal information acquired from three different dataset, surgical tools and manipulator. The results of proposed framework RNN-LSTM + DR + CLR show a 9.23 % & 3.8 % improvement in force prediction accuracy in real-time and 7.11 % & 1.68 % improvement in Visuo-haptic simulation compared to the RNN and RNN-LSTM prediction frameworks, respectively. The sensitivity analysis shows that torque (97.62 %), position (94.54 %), deformation (93.20 %), stiffness (89.23 %), tool diameter (87.25 %), rotation (63.21 %), and orientation (62.56 %) features have a respective impact on the predicted force. The performance of RNN-LSTM was better when the network was optimized with dimensionality reduction, loss function as Root Mean Square Error (RMSE), and learning rate as Cyclical Learning Rate (CLR). The research outcomes show the effectiveness of the method for estimating the force on the surface and internal layers of the skin. Also, the method has applications in real-time surgical tasks and surgeon training.

Total arthroplasty of the ankle joint : Limitations and potentials

Total arthroplasty of the ankle joint (TAA) has become an established treatment option for patients with advanced osteoarthritis of the ankle joint. Acrucial factor for good long-term clinical results and standing times is careful patient selection, taking the indications, contraindications, and defined prognostic factors into account. Despite modern prosthetic designs, TAA remains acomplex surgical procedure that requires precise surgical techniques in aspecialized center. Various limitations exist, such as the implantation technique and experience of the surgeon and perioperative complications due to concomitant medications. Current research focuses on the optimization of implant designs, development of personalized surgical techniques, improvement of the long-term performance and minimization of perioperative complications. Future developments, such as the introduction of robot-assisted surgical systems and the integration of biological procedures are also discussed as technological perspectives.

Eye-mounting goggles to bridge the gap between benchtop experiments and in vivo robotic eye surgery

A variety of robot-assisted surgical systems have been proposed to improve the precision of eye surgery. Evaluation of these systems has typically relied on benchtop experiments with artificial or enucleated eyes. However, this does not properly account for the types of head motion that are common among patients undergoing eye surgery, which a clinical robotic system will encounter. In vivo experiments are clinically realistic, but they are risky and thus require the robotic system to be at a sufficiently mature state of development. In this paper, we describe a low-cost device that enables an artificial or enucleated eye to be mounted to standard swim goggles worn by a human volunteer to enable more realistic evaluation of eye-surgery robots after benchtop studies and prior to in vivo studies. The mounted eye can rotate about its center, with a rotational stiffness matching that of an anesthetized patient’s eye. We describe surgeon feedback and technical analyses to verify that various aspects of the design are sufficient for simulating a patient’s eye during surgery.

Surgical accuracy of image-free versus image-based robotic-assisted total knee arthroplasty.

This study investigated the accuracy in achieving proper lower limb alignment and component positions after total knee replacement (TKR) with image-free and image-based robotic-assisted TKR. A total of 129 patients (166 knees) suffering from end-stage knee arthritis who underwent TKA operated by robotic-assisted surgery between the years 2018 and mid-2021 were recruited. Radiological outcomes were compared between image-free and image-based robotic-assisted surgical systems. There were significant differences between the two robotic systems when comparing the mean planned component alignment and the mean measured alignment on radiographs, in which the image-free robotic-assisted system was more varus, whereas the image-based robotic-assisted system was more valgus for both the mean femoral and tibial component coronal alignment (p<0.001). For tibial component sagittal alignment, the image-based group had a larger deviation from the planned posterior slope (p<0.001). Image-free and image-based robotic assisted TKR had differing accuracy in femoral and tibial alignment.

Augmented or Mixed Reality Enhanced Head-Mounted Display Navigation for In Vivo Spine Surgery: A Systematic Review of Clinical Outcomes.

This research paper provides a systematic literature review (SLR) on the current status of augmented-reality head-mounted devices (AR-HMDs) that guide and navigate spine surgeries and pedicle screw placement. Embase, Scopus, PubMed, Cochrane Library and IEEE Xplore databases were screened for the systematic literature search to collect and statistically analyze live patient clinical, procedural and user experience data. Multi-level Poisson and binominal models were used for analysis. In vivo patient data, only the clinically widely used Gertzbein-Robbins Scale, were published as an outcome in the recent heterogeneous literature. The statistical analysis supports the hypothesis that using AR-HMDs has the same clinical outcomes as using more expensive robot-assisted surgical (RAS) systems. AR-HMD-guided pedicle screw insertion is reaching its technology readiness, providing similar benefits to RAS. Further meta-analysis is expected in the future from higher case-numbered and standardized randomized clinical trials.