Robotic-assisted minimally invasive surgery of the spine (RAMISS): a proof-of-concept study using carbon dioxide insufflation for multilevel posterior vertebral exposure via a sub-paraspinal muscle working space

Abstract

Background: Open posterior spinal procedures involve extensive soft tissue disruption, increased hospital length of stay, and disfiguring scars. Our aim was to demonstrate the feasibility of using robotic-assistance for minimally invasive exposure of the posterolateral spine with and without carbon dioxide (CO₂ ) insufflation.

Methods: Sheep specimens underwent minimally invasive subperiosteal dissection of the spine during three trials. The da Vinci S Surgical system was used for access with and without working space support via CO₂ insufflation.

Results: Without insufflation, a sub-paraspinal muscle tunnel measuring 16 cm was developed between two 5 cm incisions. With insufflation, the one-sided tunnel length was 12.5 cm but without the soft tissue trauma and obstructed visualization experienced without CO₂ .

Conclusions: The use of robot-assistance for minimally invasive access to the posterior spine appears to be feasible. The use of CO₂ insufflation greatly improved our ability to visualize and access the posterior vertebral elements.

Keywords: MIS; carbon dioxide insufflation; endoscopy; minimal invasive surgery; orthopaedic; pediatrics; posterior spine; robotic surgery; scoliosis; single-port; spine; telesurgery.