Robotic-Assisted Endoscopic Laminotomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa441 ◽

2021 ◽

Author(s):

Yingda Li ◽

Michael Y Wang

Keyword(s):

Spine Surgery ◽

Human Error ◽

Robotic Assistance ◽

The Novel ◽

Robotic Assisted ◽

Accuracy And Precision ◽

Surgical Ergonomics ◽

Patient Consent ◽

Potential Synergy ◽

And Robotics

Abstract Endoscopy and robotics represent two emerging technologies within the field of spine surgery, the former an ultra-MIS approach minimizing the perioperative footprint and the latter leveraging accuracy and precision. Herein, we present the novel incorporation of robotic assistance into endoscopic laminotomy, applied to a 27-yr-old female with a large caudally migrated L4-5 disc herniation. Patient consent was obtained. Robotic guidance was deployed in (1) planning of a focussed laminotomy map, pivoting on a single skin entry point; (2) percutaneous targeting of the interlaminar window; and (3) execution of precision drilling, controlled for depth. Through this case, we illustrated the potential synergy between these 2 technologies in achieving precise bony removal tailored to the patient's unique pathoanatomy while simultaneously introducing safety mechanisms against human error and improving surgical ergonomics.1,2 The physicians consented to the publication of their images.

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Robotic-Assisted Spine Surgery Using the Mazor XTM System: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy200 ◽

2018 ◽

Vol 16 (4) ◽

pp. E123-E123 ◽

Cited By ~ 2

Author(s):

Lee A Tan ◽

Ronald A Lehman

Keyword(s):

Spine Surgery ◽

Screw Placement ◽

Illustrative Case ◽

Robotic Assistance ◽

Pedicle Screw Placement ◽

Robotic Assisted ◽

Patient Consent ◽

System 2 ◽

Screw Malposition ◽

Lumbar Pedicle

Abstract We demonstrate the setup and workflow of performing robotic spine surgery using the Mazor XTM system (MAZOR Robotics Inc, Orlando, Florida) in this video. An illustrative case was presented, including detailed steps for S2AI screw and lumbar pedicle screw placement using robotic assistance. A step-by-step narration is provided along with discussion of surgical nuances. Robotic spine surgery can be a safe and efficient method for screw placement, which can potentially reduce the risk of screw malposition. Spine surgeons should be familiar with this technology and keep this technique in their armamentarium. There is no identifying information in this video. A patient consent was obtained for publishing of the material included in the video.

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Artificial Intelligence and Robotics in Spine Surgery

Global Spine Journal ◽

10.1177/2192568220915718 ◽

2020 ◽

pp. 219256822091571 ◽

Cited By ~ 1

Author(s):

Jonathan J. Rasouli ◽

Jianning Shao ◽

Sean Neifert ◽

Wende N. Gibbs ◽

Ghaith Habboub ◽

...

Keyword(s):

Artificial Intelligence ◽

Spine Surgery ◽

Patient Selection ◽

Clinical Decision Making ◽

Predictive Analytics ◽

Narrative Review ◽

Robotic Assisted ◽

Spine Care ◽

And Robotics ◽

Preoperative Patient

Study Design: Narrative review. Objectives: Artificial intelligence (AI) and machine learning (ML) have emerged as disruptive technologies with the potential to drastically affect clinical decision making in spine surgery. AI can enhance the delivery of spine care in several arenas: (1) preoperative patient workup, patient selection, and outcome prediction; (2) quality and reproducibility of spine research; (3) perioperative surgical assistance and data tracking optimization; and (4) intraoperative surgical performance. The purpose of this narrative review is to concisely assemble, analyze, and discuss current trends and applications of AI and ML in conventional and robotic-assisted spine surgery. Methods: We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2019 examining AI, ML, and robotics in spine surgery. Key findings were then compiled and summarized in this review. Results: The majority of the published AI literature in spine surgery has focused on predictive analytics and supervised image recognition for radiographic diagnosis. Several investigators have studied the use of AI/ML in the perioperative setting in small patient cohorts; pivotal trials are still pending. Conclusions: Artificial intelligence has tremendous potential in revolutionizing comprehensive spine care. Evidence-based, predictive analytics can help surgeons improve preoperative patient selection, surgical indications, and individualized postoperative care. Robotic-assisted surgery, while still in early stages of development, has the potential to reduce surgeon fatigue and improve technical precision.

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Challenges of single-stage pancreatoduodenectomy: how to address pancreatogastrostomies with robotic-assisted surgery

Surgical Endoscopy ◽

10.1007/s00464-021-08925-w ◽

2021 ◽

Author(s):

Lea Timmermann ◽

Karl Herbert Hillebrandt ◽

Matthäus Felsenstein ◽

Moritz Schmelzle ◽

Johann Pratschke ◽

...

Keyword(s):

Single Stage ◽

Morbidity And Mortality ◽

R0 Resection ◽

Robotic Assistance ◽

Open Approach ◽

The Novel ◽

Robotic Assisted ◽

Robotic Assisted Surgery ◽

Operation Rate ◽

Complications And Mortality

Abstract Introduction Establishing a sufficient pancreatico-enteric anastomosis remains one of the most important challenges in open single stage pancreatoduodenectomy as they are associated with persisting morbidity and mortality. Applicability on a robotic-assisted approach, however, even increases the requirements. With this analysis we introduce a dorsal-incision-only invagination type pancreatogastrostomy (dioPG) to the field of robotic assistance having been previously proven feasible in the field of open pancreatoduodenectomy and compare initial results to the open approach by means of morbidity and mortality. Methods An overall of 142 consecutive patients undergoing reconstruction via the novel dioPG, 38 of them in a robotic-assisted and 104 in an open approach, was identified and further reviewed for perioperative parameters, complications and mortality. Results We observed a comparable R0-resection rate (p = 0.448), overall complication rate (p = 0.52) and 30-day mortality (p = 0.71) in both groups. Rates of common complications, such as postoperative pancreatic fistula (p = 0.332), postoperative pancreatic hemorrhage (p = 0.242), insufficiency of pancreatogastrostomy (p = 0.103), insufficiency of hepaticojejunostomy (p = 0.445) and the re-operation rate (p = 0.103) were comparable. The procedure time for the open approach was significantly shorter compared to the robotic-assisted approach (p = 0.024). Discussion The provided anastomosis appeared applicable to a robotic-assisted setting resulting in comparable complication and mortality rates when compared to an open approach. Nevertheless, also in the field of robotic assistance establishing a predictable pancreatico-enteric anastomosis remains the most challenging aspect of modern single-stage pancreatoduodenectomy and requires expertise and experience.

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Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients

Operative Neurosurgery ◽

10.1093/ons/opaa029 ◽

2020 ◽

Vol 19 (4) ◽

pp. 444-452 ◽

Cited By ~ 3

Author(s):

Amir H Faraji ◽

Vasileios Kokkinos ◽

James C Sweat ◽

Donald J Crammond ◽

R Mark Richardson

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Human Error ◽

Robotic Assisted ◽

Radial Error ◽

Accuracy And Precision ◽

Lead Placement ◽

Significant Difference ◽

Novel Method ◽

Deep Brain

Abstract BACKGROUND Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, adoption for this indication has not been widespread. OBJECTIVE To describe a recent robotic-assisted stereotaxy experience and workflow for DBS lead implantation in awake patients with and without microelectrode recording (MER), including considerations for intraoperative research using electrocorticography (ECoG). METHODS A retrospective review of 20 consecutive patients who underwent simultaneous bilateral DBS lead implantation using robotic-assisted stereotaxy was performed. Radial error was determined by comparing the preoperative target with the DBS lead position in the targeting plane on postoperative computed tomography. Information regarding any postoperative complications was obtained by chart review. RESULTS A novel method for robot coregistration was developed. We describe a standard workflow that allows for MER and/or ECoG research, and a streamlined workflow for cases in which MER is not required. The overall radial error for lead placement across all 20 patients was 1.14 ± 0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46 ± 0.19 mm) as compared with the second 10 patients (0.86 ± 0.09 mm). No complications were encountered. CONCLUSION Robotic-assisted stereotaxy has the potential to increase precision and reduce human error, compared to traditional frame-based DBS surgery, without negatively impacting patient safety or the ability to perform awake neurophysiology research.

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Quad S2-Alar-Iliac Screw Fixation via Navigated Spinal Robotics With Software Planning: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa155 ◽

2020 ◽

Vol 19 (5) ◽

pp. E523-E523 ◽

Cited By ~ 1

Author(s):

Martin H Pham ◽

Luis Daniel Diaz-Aguilar ◽

Bradley H King ◽

Joseph A Osorio ◽

Ronald A Lehman

Keyword(s):

Spine Surgery ◽

Surgical Procedure ◽

Screw Fixation ◽

Spinal Instrumentation ◽

Robotic Assistance ◽

Patient Consent ◽

Iliac Screws ◽

Iliac Screw ◽

Robotic Platforms

Abstract The use of robotic guidance for spinal instrumentation has become promising for its ability to offer the advantages of precision, accuracy, and reproducibility. However, utilization and adoption of robotic platforms for spine surgery remain limited especially in comparison to other surgical fields. We present here a case of a 71-yr-old man with a prior T4-pelvis long-segment fusion who presented with distal sacro-iliac instrumentation loosening with pseudarthrosis. He subsequently underwent construct revision with quad (bilateral dual) S2-alar-iliac screw fixation with navigated spinal robotic assistance (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). To our knowledge, this is the first video demonstrating the preoperative software planning and intraoperative workflow for placing quad S2-alar-iliac screws with navigated spinal robotic guidance using the Mazor X Stealth Edition. There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

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Pengaruh Kompetensi Coder terhadap Keakuratan dan Ketepatan Pengkodean Menggunakan ICD 10 di Rumah Sakit X Pekanbaru Tahun 2016

KESMARS Jurnal Kesehatan Masyarakat Manajemen dan Administrasi Rumah Sakit ◽

10.31539/kesmars.v1i1.158 ◽

2018 ◽

Vol 1 (1) ◽

pp. 31-43

Author(s):

Nur Maimun ◽

Jihan Natassa ◽

Wen Via Trisna ◽

Yeye Supriatin

Keyword(s):

Medical Record ◽

Human Error ◽

Medical Personnel ◽

Quality Of Data ◽

Accuracy And Precision ◽

Result Show ◽

Study Implementation ◽

Icd 10 ◽

The Cost

The accuracy in administering the diagnosis code was the important matter for medical recorder, quality of data was the most important thing for health information management of medical recorder. This study aims to know the coder competency for accuracy and precision of using ICD 10 at X Hospital in Pekanbaru. This study was a qualitative method with case study implementation from five informan. The result show that medical personnel (doctor) have never received a training about coding, doctors writing that hard and difficult to read, failure for making diagnoses code or procedures, doctor used an usual abbreviations that are not standard, theres still an officer who are not understand about the nomenclature and mastering anatomy phatology, facilities and infrastructure were supported for accuracy and precision of the existing code. The errors of coding always happen because there is a human error. The accuracy and precision in coding very influence against the cost of INA CBGs, medical and the committee did most of the work in the case of severity level III, while medical record had a role in monitoring or evaluation of coding implementation. If there are resumes that is not clearly case mix team check file needed medical record the result the diagnoses or coding for conformity. Keywords: coder competency, accuracy and precision of coding, ICD 10

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Comparative Study for the Assay of Plant Derived Chemicals in Pharmaceutical Formulation Using Methods Dependent on Factorized Spectra

Journal of AOAC International ◽

10.1093/jaoacint/qsab027 ◽

2021 ◽

Author(s):

Nesma M Fahmy ◽

Adel M Michael

Keyword(s):

Pharmaceutical Formulations ◽

Pharmaceutical Formulation ◽

Ternary Mixtures ◽

Ratio Method ◽

The Novel ◽

Naturally Occurring ◽

Accuracy And Precision ◽

Validation Parameters ◽

Significant Difference

Abstract Background Modern built-in spectrophotometer software supporting mathematical processes provided a solution for increasing selectivity for multicomponent mixtures. Objective Simultaneous spectrophotometric determination of the three naturally occurring antioxidants—rutin(RUT), hesperidin(HES), and ascorbic acid(ASC)—in bulk forms and combined pharmaceutical formulation. Method This was achieved by factorized zero order method (FZM), factorized derivative method (FD1M), and factorized derivative ratio method (FDRM), coupled with spectrum subtraction(SS). Results Mathematical filtration techniques allowed each component to be obtained separately in either its zero, first, or derivative ratio form, allowing the resolution of spectra typical to the pure components present in Vitamin C Forte® tablets. The proposed methods were applied over a concentration range of 2–50, 2–30, and 10–100 µg/mL for RUT, HES, and ASC, respectively. Conclusions Recent methods for the analysis of binary mixtures, FZM and FD1M, were successfully applied for the analysis of ternary mixtures and compared to the novel FDRM. All were revealed to be specific and sensitive with successful application on pharmaceutical formulations. Validation parameters were evaluated in accordance with the International Conference on Harmonization guidelines. Statistical results were satisfactory, revealing no significant difference regarding accuracy and precision. Highlights Factorized methods enabled the resolution of spectra identical to those of pure drugs present in mixtures. Overlapped spectra of ternary mixtures could be resolved by spectrum subtraction coupled FDRM (SS-FDRM) or by successive application of FZM and FD1M.

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True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Journal of Personalized Medicine ◽

10.3390/jpm11070662 ◽

2021 ◽

Vol 11 (7) ◽

pp. 662

Author(s):

Kim Huber ◽

Bernhard Christen ◽

Sarah Calliess ◽

Tilman Calliess

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Patient Specific ◽

Kinematic Alignment ◽

Postoperative Phase ◽

Robotic Assistance ◽

Component Position ◽

Joint Stability ◽

Robotic Assisted ◽

Primary Tkas

Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

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