Preliminary application study of dual-robotic navigated minimally invasive treatment by TiRobot and Artis Zeego on pelvic fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Kexin ¹ , YOU Mengzhen ¹ , HUANG Moran ² , CHEN Cheng ¹ , RUI Biyu ¹ , GAO Hong ¹ , CHEN Yunfeng ¹ , LI Xiaolin ¹ , ZHANG Wei ¹ , SUN Yuqiang ¹ ,  WANG Lei ¹

1. Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei Anhui, 230001, P. R. China;

Corresponding author：

WANG Lei, Email: wanglei2264@126.com

Keywords：

TiRobot; three-dimensional navigation; Artis Zeego system; pelvic fracture; learning curve

DOI：

10.7507/1002-1892.202203026

Video：

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Objective To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego. Methods Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m² (mean, 23.61 kg/m²). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group (n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared. Results All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened (P<0.05), but the difference in the screw implantation accuracy was not significant (P>0.05). Conclusion TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.

Citation： LIU Kexin, YOU Mengzhen, HUANG Moran, CHEN Cheng, RUI Biyu, GAO Hong, CHEN Yunfeng, LI Xiaolin, ZHANG Wei, SUN Yuqiang, WANG Lei. Preliminary application study of dual-robotic navigated minimally invasive treatment by TiRobot and Artis Zeego on pelvic fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 929-933. doi: 10.7507/1002-1892.202203026 Copy

1.	Abdelrahman H, El-Menyar A, Keil H, et al. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res, 2020, 15(1): 249. doi: 10.1186/s13018-020-01772-w.
2.	Garcia M, Firek M, Zakhary B, et al. Severe pelvic fracture in the elderly: High morbidity, mortality, and resource utilization. Am Surg, 2020, 86(10): 1401-1406.
3.	Takao M, Hamada H, Sakai T, et al. Clinical application of navigation in the surgical treatment of a pelvic ring injury and acetabular fracture. Adv Exp Med Biol, 2018, 1093: 289-305.
4.	Stübig T, Windhagen H, Krettek C, et al. Computer-assisted orthopedic and trauma surgery. Dtsch Arztebl Int, 2020, 117(47): 793-800.
5.	Thakkar SC, Thakkar RS, Sirisreetreerux N, et al. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg, 2017, 12(1): 69-76.
6.	Passias BJ, Grenier G, Buchan J, et al. Use of 3D navigation versus traditional fluoroscopy for posterior pelvic ring fixation. Orthopedics, 2021, 44(4): 229-234.
7.	Pisquiy JJ, Toraih EA, Hussein MH, et al. Utility of 3-dimensional intraoperative imaging in pelvic and acetabular fractures: A network meta-analysis. JBJS Rev, 2021, 9(6). doi: 10.2106/JBJS.RVW.20.00129.
8.	Privalov M, Beisemann N, Swartman B, et al. First experiences with intraoperative CT in navigated sacroiliac (SI) instrumentation: An analysis of 25 cases and comparison with conventional intraoperative 2D and 3D imaging. Injury, 2021, 52(10): 2730-2737.
9.	Berger-Groch J, Lueers M, Rueger JM, et al. Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures. Eur J Trauma Emerg Surg, 2020, 46(1): 107-113.
10.	Ariffin MHM, Ibrahim K, Baharudin A, et al. Early experience, setup, learning curve, benefits, and complications associated with exoscope and three-dimensional 4K hybrid digital visualizations in minimally invasive spine surgery. Asian Spine J, 2020, 14(1): 59-65.
11.	林书, 胡豇, 万仑, 等. “天玑” 骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
12.	袁伟, 孟小童, 刘欣春, 等. 机器人辅助经皮椎体后凸成形术治疗单/双节段骨质疏松性椎体压缩骨折临床疗效. 中国修复重建外科杂志, 2021, 35(8): 1000-1006.
13.	袁春明, 肖亭英, 吕静, 等. 骨科机器人辅助下与徒手胸腰椎骨折手术疗效的对比. 四川医学, 2021, 42(11): 1109-1113.
14.	Xu P, Wang H, Liu ZY, et al. An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement. J Surg Res, 2013, 185(1): 338-346.
15.	Keil H, Aytac S, Grützner PA, et al. Intraoperative imaging in pelvic surgery. Z Orthop Unfall, 2019, 157(4): 367-377.
16.	Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
17.	Hansen DG, Fabbri N. Minimally invasive fixation of pelvic metastases by CT-assisted surgical navigation. Instr Course Lect, 2021, 70: 493-502.
18.	Catala-Lehnen P, Nüchtern JV, Briem D, et al. Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: results of an experimental cadaver study. Comput Aided Surg, 2011, 16(6): 280-287.

1. Abdelrahman H, El-Menyar A, Keil H, et al. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res, 2020, 15(1): 249. doi: 10.1186/s13018-020-01772-w.
2. Garcia M, Firek M, Zakhary B, et al. Severe pelvic fracture in the elderly: High morbidity, mortality, and resource utilization. Am Surg, 2020, 86(10): 1401-1406.
3. Takao M, Hamada H, Sakai T, et al. Clinical application of navigation in the surgical treatment of a pelvic ring injury and acetabular fracture. Adv Exp Med Biol, 2018, 1093: 289-305.
4. Stübig T, Windhagen H, Krettek C, et al. Computer-assisted orthopedic and trauma surgery. Dtsch Arztebl Int, 2020, 117(47): 793-800.
5. Thakkar SC, Thakkar RS, Sirisreetreerux N, et al. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg, 2017, 12(1): 69-76.
6. Passias BJ, Grenier G, Buchan J, et al. Use of 3D navigation versus traditional fluoroscopy for posterior pelvic ring fixation. Orthopedics, 2021, 44(4): 229-234.
7. Pisquiy JJ, Toraih EA, Hussein MH, et al. Utility of 3-dimensional intraoperative imaging in pelvic and acetabular fractures: A network meta-analysis. JBJS Rev, 2021, 9(6). doi: 10.2106/JBJS.RVW.20.00129.
8. Privalov M, Beisemann N, Swartman B, et al. First experiences with intraoperative CT in navigated sacroiliac (SI) instrumentation: An analysis of 25 cases and comparison with conventional intraoperative 2D and 3D imaging. Injury, 2021, 52(10): 2730-2737.
9. Berger-Groch J, Lueers M, Rueger JM, et al. Accuracy of navigated and conventional iliosacral screw placement in B- and C-type pelvic ring fractures. Eur J Trauma Emerg Surg, 2020, 46(1): 107-113.
10. Ariffin MHM, Ibrahim K, Baharudin A, et al. Early experience, setup, learning curve, benefits, and complications associated with exoscope and three-dimensional 4K hybrid digital visualizations in minimally invasive spine surgery. Asian Spine J, 2020, 14(1): 59-65.
11. 林书, 胡豇, 万仑, 等. “天玑” 骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
12. 袁伟, 孟小童, 刘欣春, 等. 机器人辅助经皮椎体后凸成形术治疗单/双节段骨质疏松性椎体压缩骨折临床疗效. 中国修复重建外科杂志, 2021, 35(8): 1000-1006.
13. 袁春明, 肖亭英, 吕静, 等. 骨科机器人辅助下与徒手胸腰椎骨折手术疗效的对比. 四川医学, 2021, 42(11): 1109-1113.
14. Xu P, Wang H, Liu ZY, et al. An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement. J Surg Res, 2013, 185(1): 338-346.
15. Keil H, Aytac S, Grützner PA, et al. Intraoperative imaging in pelvic surgery. Z Orthop Unfall, 2019, 157(4): 367-377.
16. Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
17. Hansen DG, Fabbri N. Minimally invasive fixation of pelvic metastases by CT-assisted surgical navigation. Instr Course Lect, 2021, 70: 493-502.
18. Catala-Lehnen P, Nüchtern JV, Briem D, et al. Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: results of an experimental cadaver study. Comput Aided Surg, 2011, 16(6): 280-287.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary application study of dual-robotic navigated minimally invasive treatment by TiRobot and Artis Zeego on pelvic fractures

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