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How should we evaluate robotics in the operating theatre? A systematic review of the learning curve of robot-assisted knee arthroplasty

Hannes Vermue (UGent) , Jasper Lambrechts, Thomas Tampere (UGent) , Nele Arnout (UGent) , Edouard Auvinet (UGent) and Jan Victor (UGent)
(2020) BONE & JOINT JOURNAL. 102B(4). p.407-413
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Abstract
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.
Keywords
General Medicine, PATIENT SATISFACTION, IMPLANT ALIGNMENT, REPLACEMENT, QUALITY, TKA

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MLA
Vermue, Hannes, et al. “How Should We Evaluate Robotics in the Operating Theatre? A Systematic Review of the Learning Curve of Robot-Assisted Knee Arthroplasty.” BONE & JOINT JOURNAL, vol. 102B, no. 4, 2020, pp. 407–13, doi:10.1302/0301-620x.102b4.bjj-2019-1210.r1.
APA
Vermue, H., Lambrechts, J., Tampere, T., Arnout, N., Auvinet, E., & Victor, J. (2020). How should we evaluate robotics in the operating theatre? A systematic review of the learning curve of robot-assisted knee arthroplasty. BONE & JOINT JOURNAL, 102B(4), 407–413. https://doi.org/10.1302/0301-620x.102b4.bjj-2019-1210.r1
Chicago author-date
Vermue, Hannes, Jasper Lambrechts, Thomas Tampere, Nele Arnout, Edouard Auvinet, and Jan Victor. 2020. “How Should We Evaluate Robotics in the Operating Theatre? A Systematic Review of the Learning Curve of Robot-Assisted Knee Arthroplasty.” BONE & JOINT JOURNAL 102B (4): 407–13. https://doi.org/10.1302/0301-620x.102b4.bjj-2019-1210.r1.
Chicago author-date (all authors)
Vermue, Hannes, Jasper Lambrechts, Thomas Tampere, Nele Arnout, Edouard Auvinet, and Jan Victor. 2020. “How Should We Evaluate Robotics in the Operating Theatre? A Systematic Review of the Learning Curve of Robot-Assisted Knee Arthroplasty.” BONE & JOINT JOURNAL 102B (4): 407–413. doi:10.1302/0301-620x.102b4.bjj-2019-1210.r1.
Vancouver
1.
Vermue H, Lambrechts J, Tampere T, Arnout N, Auvinet E, Victor J. How should we evaluate robotics in the operating theatre? A systematic review of the learning curve of robot-assisted knee arthroplasty. BONE & JOINT JOURNAL. 2020;102B(4):407–13.
IEEE
[1]
H. Vermue, J. Lambrechts, T. Tampere, N. Arnout, E. Auvinet, and J. Victor, “How should we evaluate robotics in the operating theatre? A systematic review of the learning curve of robot-assisted knee arthroplasty,” BONE & JOINT JOURNAL, vol. 102B, no. 4, pp. 407–413, 2020.
@article{8656140,
  abstract     = {{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.}},
  author       = {{Vermue, Hannes and Lambrechts, Jasper and Tampere, Thomas and Arnout, Nele and Auvinet, Edouard and Victor, Jan}},
  issn         = {{2049-4394}},
  journal      = {{BONE & JOINT JOURNAL}},
  keywords     = {{General Medicine,PATIENT SATISFACTION,IMPLANT ALIGNMENT,REPLACEMENT,QUALITY,TKA}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{407--413}},
  title        = {{How should we evaluate robotics in the operating theatre? A systematic review of the learning curve of robot-assisted knee arthroplasty}},
  url          = {{http://dx.doi.org/10.1302/0301-620x.102b4.bjj-2019-1210.r1}},
  volume       = {{102B}},
  year         = {{2020}},
}

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