Best Practice Guidelines

Section 1: General protocols:

1. The use of robotic and/or assisted surgery should be discussed prior to surgery and as part of the informed consent process
2. Manufacturer’s guidelines for each system should be fully understood and followed

Section 2: Screw planning/execution:

1. The attending surgeon should plan their own screws or verify each screw plan
2. The attending surgeon should review fluoroscopy-to-CT calibration/matching
3. Surgeons should beware of skive potential and select the starting point judiciously
4. There should be a formal anatomy check following registration
5. If deviation from planned trajectory is suspected, confirm accuracy of navigation before proceeding
6. A patient-based fiducial marker is highly encouraged
7. If there is concern that navigation inaccuracy has occurred, proceed with re-verification, re-registration/re-calibration, or abandonment of robotics/navigation
8. For intraoperative CT imaging acquisition, principles of ALARA (as low as reasonably allowable) should be utilized whenever possible, especially for younger patients
9. Imaging should be considered to check implants prior to extubation

View the PDF for the full set of guidelines.