Two technological routes for orthopedic intelligent robots: the difference between 2D and 3D

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Surgical robotics originated from industrial robots, and from the development of the last two decades, people quickly and more comprehensively found the next application scenario of surgical robots – orthopedics, typically such as internal fixation of the spine, so orthopedic intelligent robots were born. From the viewpoint of workflow, the main technical route of orthopedic intelligent robots can be divided into two kinds: one is preoperative planning (based on preoperative CT) + intraoperative 2D imaging; the other is intraoperative planning (directly based on intraoperative 3D imaging).

Robotic spine surgery using 2D imaging requires the use of a 2D C-arm X-ray machine, a physician workstation, navigation and positioning, and an orthopaedic smart robot.

The approximate process is as follows:

First, a CT scan is performed preoperatively to obtain a 3D image of the patient’s surgical area, and then segmentation and 3D reconstruction are performed to obtain a virtual 3D vertebral body and segment the 3D vertebral image.

Then, the doctor can carry out surgical planning on the 3D vertebral body image to complete the preoperative surgical planning before surgery; use the C-arm to perform 2D fluoroscopy on the patient’s vertebrae during surgery to obtain 2D images, and match the intraoperative 2D fluoroscopy with the preoperative CT 3D image through the graphic alignment algorithm, which generally requires the completion of the alignment of two 2D X-ray films to the 3D CT image from different angles, so as to achieve preoperative surgical planning Alignment with the patient’s surgical position.

Afterwards, the surgery is completed through real-time tracking by navigation, automatic positioning of the robotic arm and execution of the surgical operation (the surgeon performs the surgical operation unaided or automatically by the robot).

In contrast, the technical route of robotic spine surgery using 3D imaging does not rely on preoperative CT scans. It is performed intraoperatively by scanning the patient’s surgical area with a 3D C-arm, completing the alignment of the robotic arm with the patient’s surgical position and the spatial coordinate system of the navigation device, followed by intraoperative surgical planning, execution of robotic arm-assisted positioning through navigation guidance, execution of surgical operations by the surgeon according to positioning and direction, and verification of the The implant position is verified by the navigation system, and thus the surgical operation is completed.

It can be seen that the difference between 2D and 3D orthopedic intelligent robots is mainly reflected in the complexity of the surgical process and the clarity of clinical images.

At present, Perlove Medical is one of the few manufacturers in the industry that has mastered the intraoperative 3D imaging technology of C-arm, and is also the pioneer of the whole process solution of “orthopedic surgery robot + flat 3D C-arm” in the Chinese industry. The solution adopts the integrated adaptive alignment technology, mounting the scale (i.e. calibration target) on the C-arm, and automatically completes the registration and alignment steps without the limitation of image quality by tracking and matching the motion trajectory acquired in real time with the preset trajectory. The advantage is high clinical accuracy up to sub-millimeter (0.7mm) and accuracy independent of image quality.

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