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Videoexoscopic real-time intraoperative navigation for spinal neurosurgery: a novel co-adaptation of two existing technology platforms, technical note


Image-guided approaches to spinal instrumentation and interbody fusion have been widely popularized in the last decade [1,2,3,4,5]. Navigated pedicle screws are significantly less likely to breach [2, 3, 5, 6]. Navigation otherwise remains a point reference tool because the projection is off-axis to the surgeon’s inline loupe or microscope view. The Synaptive robotic brightmatter drive videoexoscope monitor system represents a new paradigm for off-axis high-definition (HD) surgical visualization. It has many advantages over the traditional microscope and loupes, which have already been demonstrated in a cadaveric study [7]. An auxiliary, but powerful capability of this system is projection of a second, modifiable image in a split-screen configuration. We hypothesized that integration of both Medtronic and Synaptive platforms could permit the visualization of reconstructed navigation and surgical field images simultaneously. By utilizing navigated instruments, this configuration has the ability to support live image-guided surgery or real-time navigation (RTN). Medtronic O-arm/Stealth S7 navigation, MetRx, NavLock, and SureTrak spinal systems were implemented on a prone cadaveric specimen with a stream output to the Synaptive Display. Surgical visualization was provided using a Storz Image S1 platform and camera mounted to the Synaptive robotic brightmatter drive. We were able to successfully technically co-adapt both platforms. A minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and an open pedicle subtraction osteotomy (PSO) were performed using a navigated high-speed drill under RTN. Disc Shaver and Trials under RTN were implemented on the MIS TLIF. The synergy of Synaptive HD videoexoscope robotic drive and Medtronic Stealth platforms allow for live image-guided surgery or real-time navigation (RTN). Off-axis projection also allows upright neutral cervical spine operative ergonomics for the surgeons and improved surgical team visualization and education compared to traditional means. This technique has the potential to augment existing minimally invasive and open approaches, but will require long-term outcome measurements for efficacy.

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We would like to thank Synaptive Medical for their technical, personnel, and hardware support to this project. We would also like to thank Medtronic for their technical, hardware, personnel, and financial support to this project.

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Correspondence to Meng Huang.

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Conflict of interest

Dr. Paul Holman, senior author, holds a consulting agreement with Medtronic, but has no conflict of interest concerning the materials or methods used in this study. The remaining authors have no financial interest with either company, and have no conflict of interest concerning the materials or methods used in this study.

Synaptive hardware including the brightmatter drive and guide, and Storz S1 camera were provided by Synaptive Medical.

Methodist Institute of Technology, Innovation, and Education (MITIE) Laboratory space and personnel, cadaver procurement and handling, and Medtronic hardware including Stealth S7 station, O-Arm, and image-guided instruments were funded by Medtronic as part of a prescheduled regional product demonstration. They granted us unconditional access to one specimen and all tools necessary to conduct this specific study outside of their immediate product demonstration.

Neither Synaptive Medical nor Medtronic organizations were involved with design, conduct, preparation, review, or approval of the study and manuscript.

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TLIF disc shaver and trial under real time navigation (MOV 7709 kb)

Pedicle subtraction osteotomy under real time navigation (MOV 4033 kb)

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Huang, M., Barber, S.M., Steele, W.J. et al. Videoexoscopic real-time intraoperative navigation for spinal neurosurgery: a novel co-adaptation of two existing technology platforms, technical note. J Robotic Surg 12, 251–255 (2018).

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  • Real-time navigation
  • Image-guided surgery
  • Synaptive brightmatter drive
  • Medtronic stealth