Robotics in the operating room: the future of neurosurgery and spinal surgery

The presence of robots in operating rooms around the world has been expanding in recent years and will undoubtedly increase in the coming years. We must therefore get used to a surgeon of any specialty suggesting a robot-assisted surgery or one performed entirely by one or more robotic arms. Always, at least for now, controlled by the surgical team.

Robots perform more precise, more exact movements , allowing access to more difficult anatomical areas, thereby achieving lower complication rates. A robotic arm will never have a bad day; it won't hesitate to execute a movement, nor will its hand tremble. For now, they require planning and control by a human surgeon, but they are already offering us planning trajectories developed by artificial intelligence , which can also learn like us with the number of cases . Control or supervision is something that is needed at this time. However, it is very likely that robotic systems will become increasingly "intelligent," that they will know when they might be about to make a mistake and that they will even learn like us from experience. With this, it is very likely that the robots themselves will have integrated supervision mechanisms or that some robots will be the ones that control or supervise others... In any of the scenarios, at least for now, the question will arise as to who will be responsible.

Responsibility for the possible error . Of course, this would be a significant error, occurring during a person's surgical intervention. Today, I find it hard to believe that the industry would take responsibility, and I doubt medical societies or regulatory bodies would allow it either. So, for the time being, we surgeons will continue to be present.

In fact, surgeons today must be very vigilant when using this technology . Unlike other specialties, neurosurgery and spinal surgery require access to extremely delicate anatomical areas with millimeter-level limitations on our maneuverability. Therefore, many of these robotic systems also include associated software and navigation technology .

As you can imagine, with so much technology combined, errors , although rare , can occur. In fact, this is our job today: in addition to planning , we must be very vigilant in controlling execution.

Through experience, we've proven that robotics is the most precise and error-free system we have in the operating room for spinal implant placement. It allows us to perform less invasive, more targeted surgeries with smaller incisions that result in less tissue and muscle injury, and therefore less postoperative pain and faster recovery . In addition, we significantly reduce the radiation received by both the patient and surgeon . And something very new and comforting: it reduces our fatigue, which results in fewer errors.

It's true that, because it's an expensive technology, not all public or private hospitals have it. Nor is it usually covered by insurance . However, our center has always made a determined effort to incorporate technology that allows us to perform safer surgeries.

I think robotics in our field is in its infancy and that, along with artificial intelligence, we'll see more and more applications. I envision one or more robots or robotic arms performing the interventions, collaborating with each other in a similar way to how humans do today.

The presence of robots in operating rooms around the world has been expanding in recent years and will undoubtedly increase in the coming years. We must therefore get used to a surgeon of any specialty suggesting a robot-assisted surgery or one performed entirely by one or more robotic arms. Always, at least for now, controlled by the surgical team.