Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10134-10142
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10134
Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test
Jie Yu, Qi Zhang, Ming-Xing Fan, Xiao-Guang Han, Bo Liu, Wei Tian
Jie Yu, Qi Zhang, Ming-Xing Fan, Xiao-Guang Han, Bo Liu, Wei Tian, Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
Author contributions: Yu J and Zhang Q contributed equally to this work; Yu J, Zhang Q and Tian W designed the research study; Yu J, Zhang Q, Fan MX and Han XG performed the research; Yu J, Zhang Q, Fan MX and Liu B analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. U1713221.
Institutional review board statement: This study was approved by the Ethics Review Committee of Beijing Jishuitan Hospital.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The dataset was available from the corresponding author at tianwei_spine@sina.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Tian, MD, Professor, Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China. tianwei_spine@sina.com
Received: July 15, 2021
Peer-review started: July 15, 2021
First decision: August 19, 2021
Revised: August 29, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: November 26, 2021
Abstract
BACKGROUND

In robot-assisted (RA) spine surgery, the relationship between the surgical outcome and the learning curve remains to be evaluated.

AIM

To analyze the learning curve of RA pedicle screw fixation (PSF) through fitting the operation time curve based on the cumulative summation method.

METHODS

RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively. Based on the cumulative sum of the operation time, the learning curves of the two surgeons were drawn and fit to polynomial curves. The learning curve was divided into the early and late stages according to the shape of the fitted curve. The operation time and screw accuracy were compared between the stages.

RESULTS

The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases, respectively. The operation time [150 (128, 188) min vs 120 (105, 150) min, P = 0.002] and the screw accuracy (87.50% vs 96.30%, P = 0.026) of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases. In the case of Surgeon B, the operation time (177.35 ± 28.18 min vs 150.00 ± 34.64 min, P = 0.024) was significantly reduced, and the screw accuracy (91.18% vs 96.15%, P = 0.475) was slightly improved after the surgeon completed 17 RA surgeries.

CONCLUSION

After completing 17 to 18 cases of RA PSFs, surgeons can pass the learning phase of RA technology. The operation time is reduced afterward, and the screw accuracy shows a trend of improvement.

Keywords: Robot-assisted spine surgery, Pedicle screw fixation, Learning curve, Accuracy, Operation time

Core Tip: After completing 17 to 18 cases of robot-assisted pedicle screw fixations, surgeons can pass the learning phase of robot-assisted technology. The operation time is reduced afterward, and the screw accuracy shows a trend of improvement.