Perception of Robotics and Navigation by Spine Fellows and Early Attendings

Introduction
The utilization of navigation and robotics in spine surgery has been increasing; however, its impact on training and practice has still not been assessed.

Aims/Objectives
To help address the deficiency in the literature, a survey of current trainees and recent spine fellowship graduates (early-career spine surgeons) was conducted to determine their perspective of robotics and navigation in training and their experiences in practice.
Methods
The survey was administered in April 2022 to the young surgeon members of Society of Minimally Invasive Spine Surgery (SMISS) and orthopedic spine fellowship applicants from past 6 years. For analyses, only respondents who were trainees (residents or fellows) or early attendings ( < 5 years of practice) were included. Attendings with >5 years of practice were excluded. The survey gathered information regarding: 1) Demographics, 2) Training - imaging modalities exposed to during training, perceived impact of navigation and robotics on training and reasons behind a positive or negative impact, 3) Practice - imaging modalities used in practice, reasons why or why not navigation and robotics were incorporated into practice, and anticipated utilization of navigation and robotics in 5 years’ time, 4) Confidence - confidence in placing screws using different imaging modalities, and 5) Teaching - perceived impact of navigation and robotics on teaching.

Results
51 surveys were analyzed. 71% were attendings (average practice years: 2), 29% were trainees. During training, 22% of respondents were exposed to only fluoroscopy, 75% were exposed to navigation, 51% were exposed to robotics, and 40% were exposed to both navigation and robotics. 87% and 61% of respondents who had exposure to navigation and robotics, respectively, felt that it had a positive impact on their training. In practice, 28% reported utilizing only fluoroscopy, 69% reported utilizing navigation, 30% reported utilizing robotics, and 28% reported utilizing both navigation and robotics. The top 3 reasons behind positive impact on training and incorporation into practice were: 1) increased pedicle screw accuracy, 2) exposure to upcoming technology, and 3) less radiation exposure. The top 3 reasons behind negative impact on training were: 1) compromises training to independently place screws, 2) time and personnel requirements for setup, and 3) concerns about being able to avail it in practice. The top 3 reasons behind not incorporating navigation and robotics in practice were: 1) difficulty to obtain, 2) time and personnel requirements for setup, and 3) technical complexity. >65% of attendings reported that navigation and robotics had a positive impact on their ability to teach trainees. The confidence level was reported higher when placing screws with navigation and robotics than fluoroscopy. 76% of attendings felt that they will be utilizing more navigation and robotics in 5 years’ time.

Conclusions
Navigation and robotics have a positive impact on training and are increasingly being incorporated in practice. However, the associated concerns demand spine surgeons to be thoughtful about how they integrate these technologies moving forward.