Staff Nurse 2 Boston Children's Hospital Rockland, Massachusetts, United States
Description:
Background: Pediatric spine surgery has traditionally been done either by free handing pedicle screws or under fluoroscopic guidance. As technology advances, pediatric spine surgery has evolved in order to improve the safety and efficiency of pedicle screw placement. Throughout the years, computer guided navigation has been used by many pediatric spine surgeons. The computer guided navigation is based on a three-dimensional image of the patient’s anatomy. The surgeon, using the navigated instruments, coordinates their movements with the three-dimensional computerized image with the patient’s anatomy. Navigation has been shown to improve higher accuracy of pedicle screw placement than free hand or fluoroscopic guidance. As navigation developed, robotics coupled with navigation in spine surgery has slowly eliminated the potential for human error.
Implementation: Robotic assisted pedicle screw placement works in real time navigation so that the surgeon can have a rigid trajectory based on the patient’s anatomical registration with the robot. Though robotics is supportive, pediatric robotic surgery offers its own unique challenges, such as difficulty with registration, flexibility of the spine affecting accuracy and initial longer operating times.
Preparation and Planning: The surgical team was trained on the robotics software while the nursing team was trained on the robotics equipment. The radiology department was trained on the fluoroscopic equipment that will be used to get the images the robot will use to navigate the pedicles.
Outcomes: It has been seen that the benefits of accuracy of screw placement, optimization of screw size and less radiation to the patient continue to promote the use of robotics versus free hand of pedicle screws in pediatric spine surgery.
Implications for Nursing: Nurses must be familiar with the equipment and technology involved with robotics. Nursing must be aware of the possibility of emergent resuscitation, therefore, the knowledge of the robot is essential to the safety of the patient. Nursing staff, in order to best serve the patient and the surgical team, must be properly trained on the robot and its software.