Whole-Workflow Robotic-Assisted Percutaneous Endoscopic Lumbar Discectomy via a Two-Step Access Method: Technical Report and Preliminary Results.

Purpose: The spinal surgery robot can provide precise preoperative or intraoperative surgical planning and guide the implementation of the surgical plan under real-time navigation monitoring. Researchers have recently begun exploring the use of robotic systems to assist in performing Percutaneous Endoscopic Lumbar Discectomy (PELD). However, prior studies have primarily focused on robotic-assisted transforaminal puncture. In this study, we establish a two-step cannulation surgical workflow using specialized instruments to facilitate the whole-process robotic-assisted PELD. Patients and Methods: In this study, 14 patients with lumbar disc herniations were enrolled to undergo PELD assisted by a robotic system. Preoperative CT images were registered in the navigation system for surgical planning. The whole procedure was performed under spinal robotic guidance, including puncture, dilation, foraminoplasty, and working tube placement. A retrospective analysis was conducted to evaluate its feasibility and safety, as well as to summarize the surgical workflow. Results: All patients successfully completed the robotic-assisted PELD surgery. The average robot preparation time was 31.42±6.45 minutes, the cannula placement time was 9.85±2.59 minutes, and the mean operative time was 92.21±18.65 minutes. The average number of intraoperative fluoroscopy shots was 3.35±0.84. Postoperative follow-up showed significant improvement in back pain/leg pain VAS scores and ODI scores compared with preoperative values. According to the modified Macnab criteria, 8 cases were rated as excellent (57.1%), and 6 cases as good (42.9%), resulting in an overall satisfaction rate of 100%. No patients experienced severe complications such as nerve root injury or deep infection. Conclusion: Robotic assistance in PELD surgery ensures a precise preoperative planning and safe implementation, also reducing radiation exposure both patients and surgeons. With specialized instruments, the two-step access method simplifies PELD as a safe and effective surgery.