Abstract: BACKGROUND: Percutaneous kyphoplasty assisted by C-arm under local anesthesia requires continuous adjustment of the puncture direction under multiple C-arm fluoroscopy. The establishment time of the working channel is longer, and the intraoperative pain stimulation of patients is larger. With the help of the robot, the puncture can be successfully performed at one time, which can significantly improve the experience of patients and reduce the risk of bone cement leakage.
OBJECTIVE: To compare the patient experience and other outcomes of percutaneous kyphoplasty using robot-assisted and conventional C-arm fluoroscopy under local anesthesia.
METHODS: A total of 241 patients with single-stage osteoporotic vertebral compression fracture were selected from Sichuan Academy of Medical Sciences · Sichuan Provincial People’s Hospital (Affiliated Hospital, University of Electronic Science and Technology of China). 132 patients underwent robot-assisted percutaneous kyphoplasty under local anesthesia (robot-assisted group). 109 cases of conventional C-arm assisted percutaneous kyphoplasty under local anesthesia (conventional fluoroscopy group). Patients’ intraoperative experience evaluation, bone cement injection amount, operation time, working channel establishment time, hospitalization cost and complications were recorded. Puncture deviation and bone cement leakage were evaluated by imaging on the first day after surgery.
RESULTS AND CONCLUSION: (1) The intraoperative experience of 59 patients in the robot-assisted group was rated as “very good”, 43 as “good”, 16 as “average”, 10 as “poor”, and 4 as “very poor,” while that of 30 patients in the conventional fluoroscopy group was rated as “very good”, 44 cases were “good”, 21 “average”, 9 “poor”, and 5 “very poor.” There was a significant difference between the two groups in intraoperative experience evaluation (Z=-2.546, P=0.011). Intraoperative pain visual analog scale score was lower in the robot-assisted group than that in the conventional fluoroscopy group (t=-9.513, P=0.000). Totally 84 patients in the robot-assisted group and 47 patients in the conventional fluoroscopy group were willing to undergo percutaneous kyphoplasty again when necessary, and there was a significant difference between the two groups (Z=-2.730, P=0.006). (2) The operation time and hospitalization cost of the robot-assisted group were more than those of the conventional fluoroscopy group (t=2.860, P=0.003; t=36.522, P=0.000). The working channel establishment time of robot-assisted group was shorter than that of conventional fluoroscopy group (t=-27.066, P=0.000). The puncture deviation of robot-assisted group was better than that of conventional fluoroscopy group (Z=-3.656, P=0.000). The cement leakage of robot-assisted group was lower than that of conventional fluoroscopy group (χ2=7.284, P=0.007). (3) It is concluded that under local anesthesia, patients with robot-assisted percutaneous kyphoplasty have good surgical experience, with advantages of accurate puncture, short time to establish working channel, and low leakage rate of bone cement.

Key words: robot, osteoporotic vertebral compression fracture, percutaneous kyphoplasty, patient experience, local anesthesia