Robot-Assisted Positioning for Percutaneous Endoscopic Interlaminar Discectomy.

Abstract

Objective: During percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot-assisted positioning under C-arm fluoroscopy inPEID.

Methods: This study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end-effector capable of simultaneous fluoroscopy calibration and robot-to-image-space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow-up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t-tests were employed to compare differences in each clinical outcome between the preoperative and follow-up time.

Results: These techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot-assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot-assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p < 0.05, p < 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p < 0.05).

Conclusions: Through the evaluation of the system in robot-assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications.