Robotik Diz Cerrahisi
Özet
Robotik cerrahi, tıp alanında hata payını en aza indirmek ve olası komplikasyonları önlemek amacıyla geliştirilen, ortopedide implant konumlandırma, mekanik eksen restorasyonu ve bağ dengesini sağlama gibi kritik avantajlar sunan yenilikçi bir teknolojidir. İlk olarak 1986'da Robodoc ile başlayan süreç; günümüzde pasif, aktif, interaktif ve tele-operated olarak sınıflandırılan Mako, Navio, Rosa Knee ve iBlock gibi gelişmiş robotik sistemlerin geliştirilmesiyle devam etmektedir. Literatür incelendiğinde, robotik yardımlı total diz artroplastisinin (RATDP) ameliyat öncesi veya esnası planlamalarla kemik kesilerini ve implant yerleşim başarısını artırdığı, tibia komponent yerleşimindeki açısal kusurları azalttığı ve BT tarama maliyetleri dahil edildiğinde bilateral vakalarda konvansiyonel yönteme göre daha düşük 90 günlük operasyon maliyetleri sunduğu gösterilmiştir. Buna karşın, ameliyat sürelerinin daha uzun olması ve sistemlerin yüksek başlangıç yatırım maliyetleri ile cerrahi ekibin öğrenme eğrisi gibi faktörler bu teknolojinin dezavantajları arasında yer almaktadır. Sonuç olarak, yüksek operasyon maliyetleri ve teknik karmaşıklığa rağmen, robotik sistemler ortopedik cerrahide cerrahın başarı oranını artıran ve gelecekte uzaktan cerrahi gibi uygulamalara zemin hazırlayan kalıcı ve gelişimini sürdüren bir destek elemanı konumundadır.
Robotic surgery is an innovative technology developed to minimize the margin of error and prevent potential complications in the medical field, offering critical advantages in orthopedics such as implant positioning, mechanical axis restoration, and soft tissue balancing. The process, which initially began in 1986 with Robodoc, continues today with the development of advanced robotic systems like Mako, Navio, Rosa Knee, and iBlock, which are classified as passive, active, interactive, and tele-operated. Literature reviews indicate that robotic-assisted total knee arthroplasty (RATDP) increases the success rate of bone resections and implant placement through pre- or intraoperative planning, reduces angular alignment defects in tibial component positioning, and offers lower 90-day episode-of-care costs in bilateral cases compared to the conventional method when CT scan costs are included. Conversely, factors such as longer operative times, high initial investment costs of the systems, and the learning curve of the surgical team remain among the disadvantages of this technology. In conclusion, despite high operational costs and technical complexities, robotic systems stand as a permanent and evolving supportive tool in orthopedic surgery that enhances the success rate of the surgeon and paves the way for future applications like remote telesurgery.
Referanslar
Pugin F, Bucher P, Morel P. History of robotic surgery: from AESOP® and ZEUS® to da Vinci®. J Visc Surg. 2011 Oct;148(5 Suppl):e3-8. doi: 10.1016/j.jviscsurg.2011.04.007. Epub 2011 Oct 4. PMID: 21974854.
Türkeli S. Tıp Alanında Kullanılan Robotlar. Yıldız MS (ed.) Sağlıkta İleri Teknoloji Uygulamaları icinde. Ankara: Nobel Akademik Yayıncılık; 2019. p. 45-56.
Stefano GB. Robotic Surgery: Fast Forward to Telemedicine. Med Sci Monit. 2017 Apr 17;23:1856. doi: 10.12659/msm.904666. PMID: 28414709; PMCID: PMC5404821.
Jacofsky DJ, Allen M. Robotics in Arthroplasty: A Comprehensive Review. J Arthroplasty 2016;31:2353–63.
Parsley BS. Robotics in Orthopedics: A Brave New World. J Arthroplasty 2018;33:2355–7.
Digioia AM 3rd, Jaramaz B, Plakseychuk AY, et al. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002 Apr;17(3):359-64. doi: 10.1054/arth.2002.30411. PMID: 11938515.
Seon J-K, Park H-W, Yoo S-H, Song E-K. Assessing the accuracy of patient-specific guides for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016;24:3678–83.
Ollivier M, Parratte S, Lunebourg A, Viehweger E, Argenson J-N. The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial. Clin Orthop Relat Res 2016;474:60–8.
Schneider O, Troccaz J. A six-degree-of-freedom passive arm with dynamic constraints (PADyC) for cardiac surgery application: preliminary experiments. Comput Aided Surg 2001;6:340–51.
Bargar WL, Bauer A, Börner M. Primary and Revision Total Hip Replacement Using the Robodoc(R) System. Clinical Orthopaedics and Related Research (1976-2007) 1998;354:82.
Liow MHL, Chin PL, Pang H-N, Tay DKJ, Yeo SJ. THINK surgical TSolution-One® (Robodoc) total knee arthroplasty. Sicot-J 2017;3:63.
Lonner JH, Fillingham YA. Pros and Cons: A Balanced View of Robotics in Knee Arthroplasty. Journal of Arthroplasty 2018;33:2007–13.
van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016;24:3482–95.
Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic Bone and Soft Tissue Trauma in Robotic-Arm Assisted Total Knee Arthroplasty Compared With Conventional Jig-Based Total Knee Arthroplasty: A Prospective Cohort Study and Validation of a New Classification System. J Arthroplasty 2018;33:2496–501.
Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic Arm- Assisted Total Knee Arthroplasty. J Arthroplasty 2018;33:2002–6.
Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Devices 2017;14:925–7.
Schopper C, Proier P, Luger M, Gotterbarm T, Klasan A. The learning curve in robotic assisted knee arthroplasty is flattened by the presence of a surgeon experienced with robotic assisted surgery. Knee Surg Sports Traumatol Arthrosc. 2022 Jul 21:1–8. doi: 10.1007/s00167-022-07048-6. Epub ahead of print. PMID: 35864240; PMCID: PMC9302947.
LeRoy TE, Puzzitiello R, Ho B, Van Schuyver PR, Kavolus Ii JJ. Orthopaedic Trainee Views on Robotic Technologies in Orthopaedics: A Survey-Based Study. J Knee Surg. 2022 Jul 18. doi: 10.1055/s-0042-1748901. Epub ahead of print. PMID: 35850132.
Innocenti B, Bori E. Robotics in orthopaedic surgery: why, what and how? Arch Orthop Trauma Surg. 2021 Dec;141(12):2035-2042. doi: 10.1007/s00402-021-04046-0. Epub 2021 Jul 13. PMID: 34255170.
Li C, Wang L, Perka C, Trampuz A. Clinical application of robotic orthopedic surgery: a bibliometric study. BMC Musculoskelet Disord. 2021 Nov 22;22(1):968. doi: 10.1186/s12891-021-04714-7. PMID: 34809652; PMCID: PMC8609816.
Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot. 2020 Oct;16(5):1-28. doi: 10.1002/rcs.2118. Epub 2020 Jul 7. PMID: 32362063.
Stimson LN, Steelman KR, Hamilton DA, Chen C, Darwiche HF, Mehaidli A. Evaluation of Blood Loss in Conventional vs MAKOplasty Total Knee Arthroplasty. Arthroplast Today. 2022 Jul 19;16:224-228. doi: 10.1016/j.artd.2022.06.003. PMID: 35880226; PMCID: PMC9307488.
Bhowmik-Stoker M, Mathew KK, Chen Z, Chen AF, Hozack WJ, Mahoney O, Orozco FR, Mont MA. Return to Work and Driving After Robotic Arm-Assisted Total Knee Arthroplasty. Arthroplast Today. 2022 Jul 19;16:219-223. doi: 10.1016/j.artd.2022.06.002. PMID: 35880225; PMCID: PMC9307493.
Joo PY, Chen AF, Richards J, Law TY, Taylor K, Marchand K, Clark G, Collopy D, Marchand RC, Roche M, Mont MA, Malkani AL. Clinical results and patient-reported outcomes following robotic-assisted primary total knee arthroplasty: a multicentre study. Bone Jt Open. 2022 Aug;3(8):589-595. doi: 10.1302/2633-1462.37.BJO-2022-0076.R1. PMID: 35848995; PMCID: PMC9350694.
Xu J, Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhang G, Chen J. Early Clinical and Radiographic Outcomes of Robot-Assisted Versus Conventional Manual Total Knee Arthroplasty: A Randomized Controlled Study. Orthop Surg. 2022 Jul 18. doi: 10.1111/os.13323. Epub ahead of print. PMID: 35848154.
Gregory DA, Coppolecchia A, Scotti DJ, Chen Z, Mont MA, Jacofsky D. A 90-Day Episode-of-Care Analysis Including Computed Tomography Scans of Robotic-Arm Assisted versus Manual Total Knee Arthroplasty. J Knee Surg. 2022 Jul 11. doi: 10.1055/s-0042-1749083. Epub ahead of print. PMID: 35817055.
Liu P, Lu FF, Liu GJ, Mu XH, Sun YQ, Zhang QD, Wang WG, Guo WS. Robotic-assisted unicompartmental knee arthroplasty: a review. Arthroplasty. 2021 May 2;3(1):15. doi: 10.1186/s42836-021-00071-x. PMID: 35236463; PMCID: PMC8796542.
