caa a22 4500 606215395 CHVBK 20210128101058.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2535-0 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2535-0 Unskilled unawareness and the learning curve in robotic spine surgery [Elektronische Daten] [Bawarjan Schatlo, Ramon Martinez, Awad Alaid, Kajetan von Eckardstein, Reza Akhavan-Sigari, Anina Hahn, Florian Stockhammer, Veit Rohde] Background: Robotic assistance for the placement of pedicle screws has been established as a safe technique. Nonetheless rare instances of screw misplacement have been reported.The aim of the present retrospective study is to assess whether experience and time affect the accuracy of screws placed with the help of the SpineAssist™ robot system. Methods: Postoperative computed tomography (CT) scans of 258 patients requiring thoracolumbar pedicle screw instrumentation from 2008 to 2013 were reviewed. Overall, 13 surgeons performed the surgeries. A pedicle breach of >3mm was graded as a misplacement. Surgeons were dichotomised into an early and experienced period in increments of five surgeries. Results: In 258 surgeries, 1,265 pedicle screws were placed with the aid of the robot system. Overall, 1,217 screws (96.2%) were graded as acceptable. When displayed by surgeon, the development of percent misplacement rates peaked between 5 and 25 surgeries in 12 of 13 surgeons. The overall misplacement rate in the first five surgeries was 2.4% (6/245). The misplacement rate rose to 6.3% between 11 and 15 surgeries (10/158; p = 0.20), and reached a significant peak between 16 and 20 surgeries with a rate of 7.1% (8/112; p = 0.03). Afterwards, misplacement rates declined. Conclusions: A major peak in screw inaccuracies occurred between cases 10 and 20, and a second, smaller one at about 40 surgeries. One potential explanation could be a transition from decreased supervision (unskilled but aware) to increased confidence of a surgeon (unskilled but unaware) who adopts this new technique prior to mastering it (skilled). We therefore advocate ensuring competent supervision for new surgeons at least during the first 25 procedures of robotic spine surgery to optimise the accuracy of robot-assisted pedicle screws. Springer-Verlag Wien, 2015 Spine instrumentation nationallicence Pedicle screw nationallicence Robotic surgery nationallicence Spinal fusion nationallicence Computer-assisted surgery nationallicence Learning curve nationallicence Schatlo Bawarjan Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Martinez Ramon Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Alaid Awad Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut von Eckardstein Kajetan Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Akhavan-Sigari Reza Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Hahn Anina Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Stockhammer Florian Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Rohde Veit Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1819-1823 0001-6268 157:10<1819 2015 157 701 https://doi.org/10.1007/s00701-015-2535-0 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2535-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Schatlo Bawarjan Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Martinez Ramon Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Alaid Awad Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- von Eckardstein Kajetan Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Akhavan-Sigari Reza Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Hahn Anina Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Stockhammer Florian Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Rohde Veit Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1819-1823 0001-6268 157:10<1819 2015 157 701