Artificial Intelligence (AI) in SpineNova™ Robotic System

This paper starts with an overview of the different levels of autonomy on surgical robots from $\mathbf{L 0}$ to $\mathbf{L 5}$ mimicking the various levels of autonomous cars. While various vertical applications of surgical robots offer different levels of autonomy, from complete human control to reduced levels of human input for a limited range of surgical tasks, the applications of spine surgical robots still remain at an infancy stage. Big players such as Medtronic Mazor X Stealth Edition and Globus ExcelsiousGPS mainly focus on the navigation and imaging system. Although most companies are actively exploring the possibilities of automating part or all tasks during a spine procedure, few companies have realized that at clinical or commercial stage. Vista Robotics is one of the few close to enabling automation in specific tasks during a spine surgery at the clinical stage, such as discectomy and endplate preparation. The paper explains from theoretical, product development and clinical aspects how certain artificial intelligence applications on active robotic assisted spine surgery are being realized at development and clinical stages. Applications include but are not limited to: automated discectomy and endplate preparation, self-regulated intra-operative navigation, AI-enhanced preoperative surgical planning, automated endoscopic decompression, automated laminectomy. The paper further explores potential hurdles and dilemmas companies face in turning theories into products and reality.Objective: Among all different applications of AI and automation in spine surgeries, this paper focuses on the development of semi-automated handheld device and automated robotic system to achieve discectomy and endplate preparation in MIS TLIF. We developed a robotic system to automate discectomy and endplate preparation phases in order to reduce the time of surgery, to increase the volume of bone graft delivery, to optimize the quality of discectomy and endplate preparation and potentially to achieve better clinical outcomes.Methods and Tools: SpineNova includes both hand-held semi-automated discectomy and endplate preparation device, and an active robotic assisted spine system automating this procedure. The system includes hardware and software architecture, software algorithm and selfregulated navigation of the discectomy and endplate preparationResults: Numerous lab tests on cow discs demonstrate consistent improvements, including reduction in surgery time, increased volume of tissue removal, reproducibility and repeatability, and reduction in operator fatigue, etc.Conclusion: The SpineNova robotic system and the handheld device are at the pre-clinical stage and close to the commercial stage. Lab tests demonstrated positive feedback, including but not limited to increased volume of tissue removal, significant time saving from 30 minutes down to 3-4 minutes, and reproducible and consistent results in consecutively multiple lab tests, better in the robotic system than the hand-held device. More cadaver studies will be following in the next months. The SpineNova robotic system and the hand-held device to automate discectomy and endplate preparation, among all other functionalities, are targeting at benefiting surgeons and patients in the foreseeable future.