Da Vinci® Robotic assistance for anterolateral lumbar arthrodesis: results of a french multicentric study.

BACKGROUND: Da Vinci® robot (DVR®) is today the most widely used robot in visceral, urological and gynecological surgery. Thanks to its minimally invasive approach, it has demonstrated its effectiveness and improved safety in these different disciplines. The aim of our study is to report its use in anterior approach of complex lumbar surgery.

MATERIAL AND METHOD: This is a retrospective multicenter observational study. Ten robotic-assisted procedures were performed from March 2021 to May 2022. Six oblique lumbar interbody fusion (OLIF) procedures and four lumbar corporectomies were performed by anterolateral approach assisted by DVR®. The characteristics of the patients as well as the intra- and postoperative data were recorded.

RESULTS: Six men and four women underwent surgery, with a mean age of 50.5 years and a BMI of 28.6 kg/m2. No vascular injuries were reported, and no procedures required conversion to open surgery. Mean surgical time were 219 minutes for 1-level-OLIF (3 patients), 286 minutes for 2-level-OLIF (3 patients), and 390 minutes for corporectomy (4 patients). Four patients experienced non-serious adverse events due to lumbar plexus nerve damage. One patient had a vertebral body plate fracture requiring posterior revision surgery, and one patient had a psoas hematoma requiring transfusion. No abdominal wall complications or surgical site infection were found. Seven patients were reviewed at 12 months, none had complications, and all showed radiological evidence of fusion.

CONCLUSION: The use of DVR® in lumbar surgery allows a safe minimally invasive trans-peritoneal approach, but to date, it only allows hybrid procedures to be performed.