Cadmore media player playing video 10.3171/2025.4.FOCVID2521
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
10.3171/2025.4.FOCVID2521
Description:
10.3171/2025.4.FOCVID2521
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/e0356ccf-f87b-43c5-ac8a-27e4d95f88af/videoscrubberimages/Scrubber_389.jpg
Duration:
T00H09M22S
Embed URL:
https://stream.cadmore.media/player/e0356ccf-f87b-43c5-ac8a-27e4d95f88af
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/e0356ccf-f87b-43c5-ac8a-27e4d95f88af/2. 25-21.mp4?sv=2019-02-02&sr=c&sig=%2FAkfmUilDKmK4faeuXypPsgV0Geq8zV17C5SqH9aWbw%3D&st=2026-01-24T07%3A35%3A49Z&se=2026-01-24T09%3A40%3A49Z&sp=r
Upload Date:
2025-05-20T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: Robotic assisted anterior lumbar interbody fusion with the use of indocyanine green and posterior spinal fusion. Anterior lumbar interbody fusion is a well-established surgical intervention for addressing a spectrum of degenerative pathologies affecting the lumbar spine, including degenerative disk disease, disk herniation, radiculopathy, and spondylolisthesis. Traditionally, ALIF has been performed using open surgical approaches, which, while effective, is associated with significant morbidity, including increased blood loss and potential injury to surrounding structures.
SPEAKER: Similarly, there has been an exponential growth in the interest in the use of robotics for posterior spinal procedures, including the placement of lumbosacral pedicle screws. There is increasing evidence that robotic-assisted placement of pedicle screws is associated with increased accuracy compared to other modalities, such as freehand, fluoroscopy-guided, or even navigation systems. Recent advancements in robotic surgical systems have facilitated a paradigm shift in spinal procedures.
SPEAKER: The integration of robotic technology into anterior spinal fusions allows for enhanced precision in accessing the retroperitoneal space, while minimizing intraoperative blood loss and mitigating iatrogenic damage to adjacent tissues. This minimally invasive approach has demonstrated potential benefits in reducing perioperative complications, expediting post-operative recovery, and improving overall patient outcomes.
SPEAKER: Studies are warranted to elucidate the long-term advantages of robotic-assisted ALIF in comparison to conventional techniques. A 50-year-old male presented with symptoms of back and radiating leg pain that were refractory to conservative management, including physical therapy, neuropathic pain modulators, NSAIDs, and acetaminophen. Imaging was significant for a grade 1 spondylolisthesis at L5–S1.
SPEAKER: Diagnostic workup included a lumbar MRI, x-ray, and SPECT-CT, which showed greatest uptake in the L5–S1 region. Due to the findings of the spondylolisthesis at L5–S1 and the uptake around the disk space, the patient underwent bilateral transforaminal injection of lidocaine and dexamethasone at L5–S1. This injection provided temporary relief of the patient's symptoms.
SPEAKER: Patient was scheduled for a robotic-assisted anterior lumbar interbody fusion with posterior spinal fusion at L5–S1 level. The robotic-assisted approach was selected to reduce visceral manipulation, tissue damage, and risk for abdominal hernias. Written informed consent was obtained from the patient for the robotic procedure, as well as for the collection and sharing of his medical data in procedural videos for research and publication purposes.
SPEAKER: All identifying information was anonymized to maintain confidentiality. Following induction of general anesthesia and the administration of perioperative antibiotics and tranexamic acid, the patient underwent endotracheal intubation. An indwelling Foley catheter was placed. Neuromonitoring leads were placed for intraoperative nerve monitoring.
SPEAKER: The patient was positioned on a Trumpf surgical bed in the supine position, with arms in the "Superman" position, as demonstrated in the photo. Anterior access to the retroperitoneal space was gained using the da Vinci robotic system. Five incisions were made for port placement, a 5-millimeter left upper quadrant incision for the optical trocar using a 0° 5-millimeter scope, two 8-millimeter robotic ports placed in the left and right lower quadrants, two additional 8-millimeter robotic ports in the left and right midabdomen for instrument arms, and an 8-millimeter suprapubic port for manual access and future placement of a GelPort.
SPEAKER: After docking the da Vinci arms, the patient was placed in a Trendelenburg position at 27° to gain anterior access to the lumbar spine. This Trendelenburg position allowed for the disk space to be perpendicular to the floor, allowing for shorter working distance and improved surgical ergonomics compared to the traditional approach. Pneumoperitoneum was developed to 15 mm Hg. The abdominal contents were displaced superiorly or laterally, providing a clear operative field.
SPEAKER: Upon retraction of the peritoneal sac and retroperitoneal structures, the posterior abdominal wall was exposed, revealing the bifurcation of the abdominal aorta into the common iliac arteries crossing the L5–S1 intervertebral disk space. Ureters were visualized laterally and protected throughout the procedure, and the presacral nerves were mobilized. Indocyanine green is used as a near-infrared fluorescent dye to visualize blood flow in real time.
SPEAKER: After intravenous injection, ICG binds to plasma proteins, then circulates through the vasculature. When exposed to near-infrared light, it emits fluorescence, allowing for clear delineation of arteries and vascular structures. ICG fluorescence imaging was performed intraoperatively to visualize the bifurcation of the common iliac arteries, as well as the middle sacral artery, to reduce risk of vascular injury.
SPEAKER: The middle sacral artery was ligated with a 2-0 silk and transected to prevent excessive bleeding. The anterior longitudinal ligament was then revealed via dissection of retroperitoneal fat and incised to access the disk space. After visualization of the intervertebral disk space, a 3-centimeter silk suture was used as a measuring guide to determine the width of the disk space for optimal selection of the interbody spacer and cage.
SPEAKER: A 25-gauge needle was placed in the L5–S1 disk space to confirm placement, and then the area was marked with cautery. The patient was moved out of Trendelenburg position to supine. The suprapubic port was exchanged for a GelPOINT Mini to facilitate instrument exchange, while maintaining pneumoperitoneum during the disk excision. A discectomy was performed using a sheathed scalpel, and disk material was removed using a pituitary rongeur.
SPEAKER: A Cobb retractor was utilized to further clear the bony endplate and prepare the disk space for interbody cage placement in usual fashion. Following preparation of the disk space, an expandable trial was placed to further open the disk space and to assess initial fit. After confirming appropriate sizing, the spacer was placed with the Hedron IA metal interbody cage prepacked with osteogenic bone graft.
SPEAKER: Using a modified inserter, two shims were malleted into L5. This modified inserter is enclosed, allowing for safer placement of the shims. Intraoperative lateral and AP x-ray imaging confirmed proper placement of the interbody cage. After shim placement, locking mechanism was engaged. During neuromonitoring, a transient loss of right lower extremity motor signals was noted, but resolved intraoperatively with no evidence of malpositioning.
SPEAKER: Hemostasis was ensured with Floseal application and the robotic system was detached. A general surgeon performed superficial and dermal closure without deep layer approximation. A staged posterior fixation was performed 4 days after the ALIF procedure to ensure adequate indirect decompression using the ExcelsiusGPS robotic system to enhance stability, prevent cage subsidence, and promote fusion.
SPEAKER: Percutaneous screws were placed bilaterally followed by two rods. The L5–S1 joint was exposed and decorticated. Both autograft and allograft were placed to constitute a supplemental posterolateral fusion. Placement of screws was accurate in postoperative CT. The patient experienced no significant complications, with full restoration of motor function upon awakening.
SPEAKER: Estimated blood loss was minimal on both surgeries, and the total operative time for the ALIF was 4 hours. The patient felt that his preoperative preoperative back and leg pain had improved, so no formal decompression was deemed necessary. Postoperative imaging confirmed midsagittal cage placement with adequate angulation. The patient was advanced to a regular diet and was discharged on postoperative pedicle screw placement day 2, with standard follow-up scheduled.
SPEAKER: Although the operative time for the robotic ALIF is longer than the open approach, the novelty of the technique requires practice and familiarization to reduce operative time. Robotic ALIF may be the safest approach for several patients, including severely obese patients and those with extensive abdominal surgery. Further exploration into the clinical uses of the da Vinci robot will reduce OR time, making surgery more accessible and improve outcomes for patients.
SPEAKER:
Segment:0 .
[MUSIC PLAYING]
SPEAKER: Robotic assisted anterior lumbar interbody fusion with the use of indocyanine green and posterior spinal fusion. Anterior lumbar interbody fusion is a well-established surgical intervention for addressing a spectrum of degenerative pathologies affecting the lumbar spine, including degenerative disk disease, disk herniation, radiculopathy, and spondylolisthesis. Traditionally, ALIF has been performed using open surgical approaches, which, while effective, is associated with significant morbidity, including increased blood loss and potential injury to surrounding structures.
SPEAKER: Similarly, there has been an exponential growth in the interest in the use of robotics for posterior spinal procedures, including the placement of lumbosacral pedicle screws. There is increasing evidence that robotic-assisted placement of pedicle screws is associated with increased accuracy compared to other modalities, such as freehand, fluoroscopy-guided, or even navigation systems. Recent advancements in robotic surgical systems have facilitated a paradigm shift in spinal procedures.
SPEAKER: The integration of robotic technology into anterior spinal fusions allows for enhanced precision in accessing the retroperitoneal space, while minimizing intraoperative blood loss and mitigating iatrogenic damage to adjacent tissues. This minimally invasive approach has demonstrated potential benefits in reducing perioperative complications, expediting post-operative recovery, and improving overall patient outcomes.
SPEAKER: Studies are warranted to elucidate the long-term advantages of robotic-assisted ALIF in comparison to conventional techniques. A 50-year-old male presented with symptoms of back and radiating leg pain that were refractory to conservative management, including physical therapy, neuropathic pain modulators, NSAIDs, and acetaminophen. Imaging was significant for a grade 1 spondylolisthesis at L5–S1.
SPEAKER: Diagnostic workup included a lumbar MRI, x-ray, and SPECT-CT, which showed greatest uptake in the L5–S1 region. Due to the findings of the spondylolisthesis at L5–S1 and the uptake around the disk space, the patient underwent bilateral transforaminal injection of lidocaine and dexamethasone at L5–S1. This injection provided temporary relief of the patient's symptoms.
SPEAKER: Patient was scheduled for a robotic-assisted anterior lumbar interbody fusion with posterior spinal fusion at L5–S1 level. The robotic-assisted approach was selected to reduce visceral manipulation, tissue damage, and risk for abdominal hernias. Written informed consent was obtained from the patient for the robotic procedure, as well as for the collection and sharing of his medical data in procedural videos for research and publication purposes.
SPEAKER: All identifying information was anonymized to maintain confidentiality. Following induction of general anesthesia and the administration of perioperative antibiotics and tranexamic acid, the patient underwent endotracheal intubation. An indwelling Foley catheter was placed. Neuromonitoring leads were placed for intraoperative nerve monitoring.
SPEAKER: The patient was positioned on a Trumpf surgical bed in the supine position, with arms in the "Superman" position, as demonstrated in the photo. Anterior access to the retroperitoneal space was gained using the da Vinci robotic system. Five incisions were made for port placement, a 5-millimeter left upper quadrant incision for the optical trocar using a 0° 5-millimeter scope, two 8-millimeter robotic ports placed in the left and right lower quadrants, two additional 8-millimeter robotic ports in the left and right midabdomen for instrument arms, and an 8-millimeter suprapubic port for manual access and future placement of a GelPort.
SPEAKER: After docking the da Vinci arms, the patient was placed in a Trendelenburg position at 27° to gain anterior access to the lumbar spine. This Trendelenburg position allowed for the disk space to be perpendicular to the floor, allowing for shorter working distance and improved surgical ergonomics compared to the traditional approach. Pneumoperitoneum was developed to 15 mm Hg. The abdominal contents were displaced superiorly or laterally, providing a clear operative field.
SPEAKER: Upon retraction of the peritoneal sac and retroperitoneal structures, the posterior abdominal wall was exposed, revealing the bifurcation of the abdominal aorta into the common iliac arteries crossing the L5–S1 intervertebral disk space. Ureters were visualized laterally and protected throughout the procedure, and the presacral nerves were mobilized. Indocyanine green is used as a near-infrared fluorescent dye to visualize blood flow in real time.
SPEAKER: After intravenous injection, ICG binds to plasma proteins, then circulates through the vasculature. When exposed to near-infrared light, it emits fluorescence, allowing for clear delineation of arteries and vascular structures. ICG fluorescence imaging was performed intraoperatively to visualize the bifurcation of the common iliac arteries, as well as the middle sacral artery, to reduce risk of vascular injury.
SPEAKER: The middle sacral artery was ligated with a 2-0 silk and transected to prevent excessive bleeding. The anterior longitudinal ligament was then revealed via dissection of retroperitoneal fat and incised to access the disk space. After visualization of the intervertebral disk space, a 3-centimeter silk suture was used as a measuring guide to determine the width of the disk space for optimal selection of the interbody spacer and cage.
SPEAKER: A 25-gauge needle was placed in the L5–S1 disk space to confirm placement, and then the area was marked with cautery. The patient was moved out of Trendelenburg position to supine. The suprapubic port was exchanged for a GelPOINT Mini to facilitate instrument exchange, while maintaining pneumoperitoneum during the disk excision. A discectomy was performed using a sheathed scalpel, and disk material was removed using a pituitary rongeur.
SPEAKER: A Cobb retractor was utilized to further clear the bony endplate and prepare the disk space for interbody cage placement in usual fashion. Following preparation of the disk space, an expandable trial was placed to further open the disk space and to assess initial fit. After confirming appropriate sizing, the spacer was placed with the Hedron IA metal interbody cage prepacked with osteogenic bone graft.
SPEAKER: Using a modified inserter, two shims were malleted into L5. This modified inserter is enclosed, allowing for safer placement of the shims. Intraoperative lateral and AP x-ray imaging confirmed proper placement of the interbody cage. After shim placement, locking mechanism was engaged. During neuromonitoring, a transient loss of right lower extremity motor signals was noted, but resolved intraoperatively with no evidence of malpositioning.
SPEAKER: Hemostasis was ensured with Floseal application and the robotic system was detached. A general surgeon performed superficial and dermal closure without deep layer approximation. A staged posterior fixation was performed 4 days after the ALIF procedure to ensure adequate indirect decompression using the ExcelsiusGPS robotic system to enhance stability, prevent cage subsidence, and promote fusion.
SPEAKER: Percutaneous screws were placed bilaterally followed by two rods. The L5–S1 joint was exposed and decorticated. Both autograft and allograft were placed to constitute a supplemental posterolateral fusion. Placement of screws was accurate in postoperative CT. The patient experienced no significant complications, with full restoration of motor function upon awakening.
SPEAKER: Estimated blood loss was minimal on both surgeries, and the total operative time for the ALIF was 4 hours. The patient felt that his preoperative preoperative back and leg pain had improved, so no formal decompression was deemed necessary. Postoperative imaging confirmed midsagittal cage placement with adequate angulation. The patient was advanced to a regular diet and was discharged on postoperative pedicle screw placement day 2, with standard follow-up scheduled.
SPEAKER: Although the operative time for the robotic ALIF is longer than the open approach, the novelty of the technique requires practice and familiarization to reduce operative time. Robotic ALIF may be the safest approach for several patients, including severely obese patients and those with extensive abdominal surgery. Further exploration into the clinical uses of the da Vinci robot will reduce OR time, making surgery more accessible and improve outcomes for patients.
SPEAKER:
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode