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The da Vinci Robotic Surgical Assisted Anterior Lumbar Interbody Fusion: Technical Development and Case Report

Beutler, William J. MD*; Peppelman, Walter C. Jr DO*; DiMarco, Luciano A. DO

doi: 10.1097/BRS.0b013e31826b3d72

Study Design. Technique development to use the da Vince Robotic Surgical System for anterior lumbar interbody fusion at L5–S1 is detailed. A case report is also presented.

Objective. To evaluate and develop the da Vinci robotic assisted laparoscopic anterior lumbar stand-alone interbody fusion procedure.

Summary of Background Data. Anterior lumbar interbody fusion is a common procedure associated with potential morbidity related to the surgical approach. The da Vinci robot provides intra-abdominal dissection and visualization advantages compared with the traditional open and laparoscopic approach.

Methods. The surgical techniques for approach to the anterior lumbar spine using the da Vinci robot were developed and modified progressively beginning with operative models followed by placement of an interbody fusion cage in the living porcine model. Development continued to progress with placement of fusion cage in a human cadaver, completed first in the laboratory setting and then in the operating room. Finally, the first patient with fusion completed using the da Vinci robot–assisted approach is presented.

Results. The anterior transperitoneal approach to the lumbar spine is accomplished with enhanced visualization and dissection capability, with maintenance of pneumoperitoneum using the da Vinci robot. Blood loss is minimal. The visualization inside the disc space and surrounding structures was considered better than current open and laparoscopic techniques.

Conclusion. The da Vinci robot Surgical System technique continues to develop and is now described for the transperitoneal approach to the anterior lumbar spine.

Level of Evidence: 4

The da Vinci Surgical System was progressively evaluated and developed for robotic assisted laparoscopic anterior lumbar stand-alone instrumented lumbar fusion surgery. The robot provides intra-abdominal dissection and visualization advantages compared with traditional approaches. A case report of the first patient treated using da Vinci robotic assisted anterior lumbar interbody fusion surgery is presented.

*Pennsylvania Spine Institute, PinnacleHealth System, Harrisburg, PA, and

Central Pennsylvania Surgical Associates, PinnacleHealth System, Harrisburg, PA.

Address correspondence and reprint requests to William J. Beutler, MD, Pennsylvania Spine Institute, PinnacleHealth System, 805 Sir Thomas Court, Harrisburg, PA 17109; E-mail:

Acknowledgment date: March 29, 2012. First revision date: June 11, 2012. Second revision date: July 16, 2012. Acceptance date: July 21, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2013 Lippincott Williams & Wilkins, Inc.