#221 Robot Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Prof. Bhavuk Garg

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry:

Introduction: Lumbar-spine fusion has good outcomes. While errors may cause complications, use of navigation increases precision and prevents them. We demonstrate the surgical procedure of a robot-assisted Trans-Foraminal Lumbar Inter-Body Fusion to emphasize the need for robotics in spine surgeries.

Technique: Once patient is positioned prone and after site preparation, skin incision is given. Subcutaneous tissue is dissected and fascia incised. Paraspinal muscles are elevated subperiosteally I/L . Hemostasis is achieved and Pars, Transverse process and SAP junction identified. Trackers are applied to B/L PSIS. O-Arm Spin is taken and calibration achieved on the robot. The robotic arm is calibrated with instruments through the IR camera. Screw trajectory is planned on the robot and confirmed. The robot introduces its arm in the surgical field and directs it at the ideal entry point with the planned trajectory. Screws are inserted in the required levels. Rod is applied to the C/L side and robot assisted Ipsilateral laminectomy, pars osteotomy, inferior facetectomy of the superior vertebra and partial facetectomy of the inferior vertebra is performed. Flavum is debrided and epidural vessels are coagulated. Anullotomy is performed via the robotic arm. Robot assisted shaving of the IVD space followed by cage placement is done. Rod is applied and wound is washed and closed in layers.

Discussion: Robot assisted TLIF improves precision, prevents pedicle breech during screw placement and ensures proper cage placement. Though the upfront cost and learning curve may be discouraging, the use of this technology allows for safer surgeries and more confidence.

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