How should we evaluate robotics in the operating theatre? 2020

Hannes Vermue, and Jasper Lambrechts, and Thomas Tampere, and Nele Arnout, and Edouard Auvinet, and Jan Victor
Department of Orthopaedic Surgery, Ghent University Hospital, Gent, Belgium.

The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking. This systematic review aims to evaluate the current evidence on the learning curve of robot-assisted knee arthroplasty. An extensive literature search of PubMed, Medline, Embase, Web of Science, and Cochrane Library was conducted. Randomized controlled trials, comparative studies, and cohort studies were included. Outcomes assessed included: time required for surgery, stress levels of the surgical team, complications in regard to surgical experience level or time needed for surgery, size prediction of preoperative templating, and alignment according to the number of knee arthroplasties performed. A total of 11 studies met the inclusion criteria. Most were of medium to low quality. The operating time of robot-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is associated with a learning curve of between six to 20 cases and six to 36 cases respectively. Surgical team stress levels show a learning curve of seven cases in TKA and six cases for UKA. Experience with the robotic systems did not influence implant positioning, preoperative planning, and postoperative complications. Robot-assisted TKA and UKA is associated with a learning curve regarding operating time and surgical team stress levels. Future evaluation of robotics in the operating theatre should include detailed measurement of the various aspects of the total operating time, including total robotic time and time needed for preoperative planning. The prior experience of the surgical team should also be evaluated and reported. Cite this article: Bone Joint J 2020;102-B(4):407-413.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D002983 Clinical Competence The capability to perform acceptably those duties directly related to patient care. Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000073397 Occupational Stress Adverse psychological and behavioral reactions caused by the pressures and demands of employers or clients or other factors, such as the physical environment of the workplace, WORKPLACE VIOLENCE; or WORKPLACE BULLYING. Job Control,Job Demands,Work Stress,Workplace Abuse,Job Stress,Job-related Stress,Professional Stress,Work Place Stress,Work-related Stress,Workplace Bullying,Workplace Stress,Abuse, Workplace,Bullying, Workplace,Demand, Job,Job Demand,Job Stresses,Job related Stress,Job-related Stresses,Occupational Stresses,Professional Stresses,Stress, Job,Stress, Job-related,Stress, Occupational,Stress, Professional,Stress, Work,Stress, Work Place,Stress, Work-related,Stress, Workplace,Stresses, Workplace,Work Place Stresses,Work Stresses,Work related Stress,Work-related Stresses,Workplace Abuses,Workplace Stresses
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D061646 Operative Time The duration of a surgical procedure in hours and minutes. Length of Operative Time,Surgical Time,Time Length of Surgery,Operative Time Length,Operative Time Lengths,Operative Times,Surgery Time Length,Surgery Time Lengths,Surgical Times,Time Length, Operative,Time Lengths, Operative,Time, Operative,Time, Surgical,Times, Operative,Times, Surgical
D019317 Evidence-Based Medicine An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006) Medicine, Evidence-Based,Evidence Based Medicine,Medicine, Evidence Based
D019645 Arthroplasty, Replacement, Knee Replacement of the knee joint. Knee Replacement, Total,Arthroplasties, Knee Replacement,Arthroplasties, Replacement, Knee,Arthroplasty, Knee Replacement,Arthroplasty, Replacement, Partial Knee,Knee Arthroplasty,Knee Arthroplasty, Total,Knee Replacement Arthroplasties,Knee Replacement Arthroplasty,Partial Knee Arthroplasty,Partial Knee Replacement,Replacement Arthroplasties, Knee,Replacement Arthroplasty, Knee,Replacement, Total Knee,Total Knee Replacement,Unicompartmental Knee Arthroplasty,Unicompartmental Knee Replacement,Unicondylar Knee Arthroplasty,Unicondylar Knee Replacement,Arthroplasty, Knee,Arthroplasty, Partial Knee,Arthroplasty, Total Knee,Arthroplasty, Unicompartmental Knee,Arthroplasty, Unicondylar Knee,Knee Arthroplasty, Partial,Knee Arthroplasty, Unicompartmental,Knee Arthroplasty, Unicondylar,Knee Replacement, Partial,Knee Replacement, Unicompartmental,Knee Replacement, Unicondylar,Total Knee Arthroplasty
D020370 Osteoarthritis, Knee Noninflammatory degenerative disease of the knee joint consisting of three large categories: conditions that block normal synchronous movement, conditions that produce abnormal pathways of motion, and conditions that cause stress concentration resulting in changes to articular cartilage. (Crenshaw, Campbell's Operative Orthopaedics, 8th ed, p2019) Osteoarthritis of Knee,Osteoarthritis of the Knee,Knee Osteoarthritides,Knee Osteoarthritis
D065287 Robotic Surgical Procedures Surgical procedures performed remotely using a computer that controls surgical instruments attached to mechanical arms designed to perform the tasks of the surgeon. Robot Surgery,Robot-Assisted Surgery,Robot-Enhanced Procedures,Robot-Enhanced Surgery,Robotic-Assisted Surgery,Surgical Procedures, Robotic,Procedure, Robot-Enhanced,Procedure, Robotic Surgical,Procedures, Robotic Surgical,Robot Assisted Surgery,Robot Enhanced Procedures,Robot Enhanced Surgery,Robot Surgeries,Robot-Assisted Surgeries,Robot-Enhanced Procedure,Robot-Enhanced Surgeries,Robotic Assisted Surgery,Robotic Surgical Procedure,Robotic-Assisted Surgeries,Surgery, Robot,Surgery, Robot-Assisted,Surgery, Robot-Enhanced,Surgery, Robotic-Assisted,Surgical Procedure, Robotic

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