Potential Roles of Teamwork and Unmet Needs on Surgical Learning Curves of Spinal Robotic Screw Placement

Abstract

Yu-Feng Su,1– 3 Tai-Hsin Tsai,2– 4 Keng-Liang Kuo,2,4 Chieh-Hsin Wu,2,4 Cheng-Yu Tsai,1,2 Yen-Mou Lu,5 Shiuh-Lin Hwang,6 Pei-Chen Lin,7 Ann-Shung Lieu,2 Chih-Lung Lin,1,2,4 Chih-Hui Chang1,2,4 1Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 3Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 6Department of Spinal Surgery, Chi-Hsien Spine Hospital, Kaohsiung, Taiwan; 7Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCorrespondence: Chih-Hui Chang, Email [email protected]: The aim of this study was to investigate the learning curve of robotic spine surgery quantitatively with the well-described power law of practice.Methods: Kaohsiung Medical University Hospital set up a robotic spine surgery team by the neurosurgery department in 2013 and the orthopedic department joined the well-established team in 2014. A total of consecutive 150 cases received robotic assisted spinal surgery. The 150 cases, with 841 transpedicular screws were enrolled into 3 groups: the first 50 cases performed by neurosurgeons, the first 50 cases by orthopedic surgeons, and 50 cases by neurosurgeons after the orthopedic surgeons joined the team. The time per screw and accuracy by each group and individual surgeon were analyzed.Results: The time per screw for each group was 9.56 ± 4.19, 7.29 ± 3.64, and 8.74 ± 5.77 minutes, respectively, with p-value 0.0017. The accuracy was 99.6% (253/254), 99.5% (361/363), and 99.1% (222/224), respectively, with p-value 0.77. Though the first group took time significantly more on per screw placement but without significance on the nonlinear parallelism F-test. Analysis of 5 surgeons and their first 10 cases of short segment surgery showed the time per screw by each surgeon was 12.28 ± 5.21, 6.38 ± 1.54, 8.68 ± 3.10, 6.33 ± 1.90, and 6.73 ± 1.81 minutes. The first surgeon who initiated the robotic spine surgery took significantly more time per screw, and the nonlinear parallelism test also revealed only the first surgeon had a steeper learning curve.Conclusion: This is the first study to demonstrate that differences of learning curves between individual surgeons and teams. The roles of teamwork and the unmet needs due to lack of active perception are discussed.Keywords: human computer communication, human–robot collaboration, learning curve, robotic spine surgery, teamwork

Keywords

• human computer communication
• human-robot collaboration
• learning curve
• robotic spine surgery
• teamwork