Comparison of No Tap (two-step) and tapping robotic assisted cortical bone trajectory screw insertion.

Workflow for cortical bone trajectory (CBT) screws includes tapping line-to-line or under tapping by 1 mm. We describe a non-tapping, two-step workflow for CBT screw placement, and compare the safety profile and time savings to the Tap (three-step) workflow. Patients undergoing robotic assisted 1-3 level posterior fusion with CBT screws for degenerative conditions were identified and separated into either a No-Tap or Tap workflow. Number of total screws, screw-related complications, estimated blood loss, operative time, robotic time, and return to the operating room were collected and analyzed. There were 91 cases (458 screws) in the No-Tap and 88 cases (466 screws) in the Tap groups, with no difference in demographics, revision status, ASA grade, approach, number of levels fused or diagnosis between cohorts. Total robotic time was lower in the No-Tap (26.7 min) versus the Tap group (30.3 min, p = 0.053). There was no difference in the number of malpositioned screws identified intraoperatively (10 vs 6, p = 0.427), screws converted to freehand (3 vs 3, p = 0.699), or screws abandoned (3 vs 2, p = 1.000). No pedicle/pars fracture or fixation failure was seen in the No-Tap cohort and one in the Tap cohort (p = 1.00). No patients in either cohort were returned to OR for malpositioned screws. This study showed that the No-Tap screw insertion workflow for robot-assisted CBT reduces robotic time without increasing complications.

Early experience with focused telemedicine implementation in an academic colorectal surgery practice.

BACKGROUND: The need to continue providing care to patients during the corona virus disease 2019 pandemic facilitated telemedicine's rapid adoption, including in surgical clinic settings. Our purpose was to evaluate integration of telemedicine into an academic colorectal surgery practice and assess physician experiences providing telemedicine care. METHODS: Patients seen in colorectal surgery clinic by telemedicine and in person from March 31, 2020 to August 31, 2020 were evaluated. Demographic and clinical outcomes were assessed for patients. Physician responses to a survey were collected. RESULTS: Two hundred and thirty-one telemedicine visits were performed by 4 physicians, comprising 20% of visits during the study period. Patients were 47.6% male and 90.9% Caucasian. In addition, 85.7% were established patients and 21.2% were postoperative visits. Diagnoses evaluated by telemedicine included benign and malignant anorectal and colorectal disease as well as inflammatory bowel disease. All providers reported being able to provide adequate care via telemedicine and were planning to continue providing telemedicine. Patients seen via telemedicine were more likely to be Caucasian and less likely to be African American (P < .001) and more likely to be established patients than those seen in person (P < .001). CONCLUSION: During the COVID-19 pandemic, telemedicine was most successfully used to facilitate care for established patients, particularly the long-term care of colorectal cancer and inflammatory bowel disease. We identified significant differences in ethnicity between patients seen via telemedicine and those seen in person. Telemedicine represents an exciting advancement in patient care, although ongoing study is required regarding providing access to this technology to all colorectal surgery patients, particularly minority populations.