Robotic assisted surgery is an advancement from computer navigated technology, which utilizes intraoperative computer navigation to guide bone cuts and ligament balancing in real time, before committing to any actual bone resections. The implants and final end product with regards to general alignment, ligament balancing, angulation and rotation can be illustrated on the computer prior to actual bone preparations or implantations.
Secured arrays on set points of the limb are detected by robotic sensors following sequential rotational, range of joint movement and stress manoeuvres in addition to other data point collections. Information such as mechanical axis, ligament tension throughout the joint range and 3D spatial orientation of the joint is computerized and depicted.
A 3-Dimensional display of the joint is seen on the monitor pre and post correction, and pre- and post-implantation. This image is on a sterile touch screen monitor and allows for interactive visualization and alteration in 3 dimensions. This allows for a virtual complete and perfected final projected end product, as a result of the ability to see the resections and implants with full spatial detail at a swipe of a finger. Furthermore, important elements such as ligament balancing is plotted on a graph and assists in more accurate and predictable end points to the surgery.
Surgical compromises are not uncommon in reconstructive surgery. With computed navigated surgery, these compromises can be better planned and trialled virtually. This information input leads to a computer generated visual feedback on the final product for stability, orientation, symmetry in tightness or laxity and kinematics in the entire joint range, tailor made for the index patient’s individual deformity correction. This virtual representation offers the benefit of testing these compromises prior to any actual bone resections.
A robotic arm assists in performing the pre-mapped bone cuts by either controlling resections within the mapped out zones, and also by fine tuning jig placement in real time and ensuring it is secured within the least acceptable error margin. Once committed, the final bone preparation and implant insertion is performed. The reconstructed prosthetic joint can then be assessed and plotted onto the computer graphically and as a final virtual image. This information allows for a quantified analysis of the deformity correction in comparison to the pre- op baseline. The final alignment, angulation, rotation, tension and stability throughout the joint range can be appreciated on the computer monitor and the final corrections can be quantified accurately.
Ultimately the benefit of greater accuracy and predictability which is achieved in robotic surgery is associated with a slight limitation, and that is relatively prolonged surgical time as compared to patient specific instrumentation and even traditional manual instrumentation.