1. While robotic spine surgery presents as an exciting new technology to improve precision in insertion of screws into the spine, here is a candid summary of its disadvantages specific to the Indian scenario, so that a patient can take a well-informed and well-educated decision regarding his/ her treatment;·       
  2. Cost; This is the biggest hindrance in a cost-conscious society like ours. A part of the investment-cost on these equipments running into crores is certainly going to be passed on to the patient [reference 1]
  3. Radiation; CONTRARY to claims of reduced radiation with robotic and spine surgery, use of intraoperative CT and O-arm can lead to an increased lifetime CANCER risk by2.3 incidents per 10,000 AS COMPARED TO CONVENTIONAL RADIOGRAPHY [reference 2].       
  4. Human surgeon’s factor cannot be ruled out; Numerous unreported anecdotal reports of surgical robot missing the ideal trajectory due to deflection owing to hypertrophied facet joints are coming up which obviate the so called supremacy of robot over the human!·       
  5. Risk of infection; In a propensity matched study involving 3 groups of patients; robotic spine surgery, conventional MIS surgery and conventional open surgery for posterior lumbar fusion surgeries, it was noted that the highest complication [in the form of infection, implant failure, etc.] was noted with robotic spine surgery [reference 3]!·       
  6. Longer duration of surgery·       
  7. Insurance coverage issues

Considering all the above issues, robotic spine surgery in the present form is more a luxury than a necessity in the Indian scenario as most well-trained spine surgeons will agree that the need for these gadgets may be justified only in an extremely deformed spine with hypoplastic pedicles. But then, a well-trained spine surgeon would also be knowing alternative methods of fixations such as use of sublaminar wires or hooks or lateral mass screws in these kinds of situations to do justice to the patient EVEN IN THE ABSENCE OF THE ROBOT!

References;

  1. D'SouzaM et al. Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And FutureTrends [published correction appears in Robot Surg. 2019 Dec 23;6:25]. RobotSurg. 2019;6:9-23. Published 2019 Nov 7. READ THIS ARTICLE ON https://www.tandfonline.com/doi/full/10.2147/RSRR.S190720
  2. Crawford,Alexander M, et al. Projected Lifetime Cancer Risk Associated WithIntraoperative Computed Tomography for Lumbar Spine Surgery. Spine 48(13):p893-900, July 1, 2023. READ THIS ARTICLE ON https://journals.lww.com/spinejournal/abstract/2023/07010/projected_lifetime_cancer_risk_associated_with.1.aspx
  3. Passias PG et al. A cost benefit analysis ofincreasing surgical technology in lumbar spine fusion. Spine J. 2021Feb;21(2):193-201. doi: 10.1016/j.spinee.2020.10.012. Epub 2020 Oct 15. READTHIS ARTICLE ON https://www.thespinejournalonline.com/article/S1529-9430(20)31162-1/abstract  

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