Search

Ergonomics is an emerging concept in the neurosurgical operating theatre, where neurosurgeons work under great concentration and frequently neglect their uncomfortable body posture. Work-related musculoskeletal disorders (WMSD) are becoming a widespread burden in the neurosurgical community. WMSD have a negative impact on surgical performance and decrease the surgeons' quality of life. Here we present our single-centre 2-month experience with the Aesculap AEOS ® Robotic Digital Microscope (RDM) and prospectively calculate the REBA (Rapid Entire Body Assessment) scores and compare them with similar neurosurgical cases operated with a conventional operative microscope (OPMI).Materials and Methods: For a period of 2 months at the Department of Neurosurgery of the University Hospital Pirogov, Sofia, Bulgaria, 41 consecutive patients were operated on using RDM. The REBA employee assessment worksheets were filled in prospectively to assess the ergonomics of the senior author (N.G.) while using the RDM and the OPMI.Results and Conclusion: The ergonomics during neurosurgical operations could be substantially improved with the implementation of the exoscope. For challenging cranial approaches, where the operator must frequently "look around corners" the exoscope has a major advantage compared with the OPMI-the REBA score is 2.6 times lower for the exoscope and reaches a low risk for WMSD. For spinal operations, the neck score as part of the REBA score is three times lower for the exoscope., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Introduction: Various minimally invasive spine surgery (MISS) techniques have been developed with the goal of reducing approach-related soft-tissue trauma and its associated complications. However, there is still a debate on some of the potential drawbacks of MISS techniques, such as their longer operating times and increased intraoperative radiation. A solution to these disadvantages could be the implementation of new technologies, such as computer-assisted navigation (CAN) and surgical robotics. We compare the standard fluoroscopy MISS technique with our experience with time per screw and X-ray exposure for pedicle screw placement using the Brainlab Cirq passive robotic arm assistance coupled with the Brainlab Curve navigation system., Methods: In the Cirq robot-assisted group (Group I), 109 screws were placed in 24 prospectively analyzed patients. In the fluoroscopy-guided group, 108 screws inserted into 20 consecutive patients were analyzed retrospectively (Group II). The duration of surgery, the time to place one screw, the X-ray exposition, and the pedicle screw accuracy for each patient were recorded and reviewed., Results: In total, 217 screws were analyzed. The treated levels ranged from T10 to S1. In Group I, 104 screws were grade A (95.4%) and five were grade B (4.6%). In Group II, 96 screws were grade A (88.89%); ten were grade B (9.26%); one was grade C (0.93%), and one was grade D (0.93%). While the screws placed by using the Cirq system were more accurate overall, there was no statistical significance when the two groups were compared, p = 0.3724. There was no significant difference in radiation exposure between the two groups, p = 0.5482; however the radiation exposure for the surgeon was very limited with the Cirq system. There was a significant reduction in the operation length (p = 0.0183) and the time per screw (p < 0.0001) for Group I., Conclusions: The CAN systems and emerging robotic platforms have the potential to diminish the main disadvantages of MISS techniques-longer operation times and X-ray exposure, at least for the surgical team., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)