case_images: PMC9491466_01
case_images: Cross section (A) and sagittal (B) T2-weighted MRI demonstrated destruction at the L1/2 intervertebral space and a partial L2 vertebral body (red arrow). The location of the working channel was planned before operation (C). Thirty months after the operation, the x-ray of the lumbar spine performed in the positive position (D) and the lateral position (E) showed the formation and fusion of the vertebrae.
case_images: fsurg-09-930536-g001.jpg
case_images: PMC9491466_01_fsurg-09-930536-g001.jpg
case_images: F1
case_images: Lumbar spine x-ray showed L1/2 intervertebral disc destruction; lumbar CT three-dimensional reconstruction showed lesions in the L1/2 vertebral body, intervertebral disc, and surrounding soft tissue lesions, the results from lumbar MRI scan for L1/2 vertebral body, intervertebral disc, and surrounding soft tissue were considered to show infectious lesions (Figures 1A,B). The Da Vinci XI Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was placed on the head side of the patient, with the medial axis aligned to the retroperitoneal space (Figure 2). The placement of the working channel was planned before operation (Figure 1C). Thirty months after the operation, x-ray examination showed intervertebral bone formation and fusion (Figures 1D,E).
case_images: Robotic instrumentation, personnel, and operating room setup for the laparoscopic retroperitoneal approach.
case_images: fsurg-09-930536-g002.jpg
case_images: PMC9491466_01_fsurg-09-930536-g002.jpg
case_images: F2
case_images: The Da Vinci XI Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was placed on the head side of the patient, with the medial axis aligned to the retroperitoneal space (Figure 2). The placement of the working channel was planned before operation (Figure 1C).
case_images: Operative instruments for robot-assisted laparoscopic retroperitoneal debridement surgery. Scale bar = 15 cm.
case_images: fsurg-09-930536-g003.jpg
case_images: PMC9491466_01_fsurg-09-930536-g003.jpg
case_images: F3
case_images: All the operative instruments are shown in Figure 3, which included the nucleus pulposus forceps kit, lamina rongeur kit, stripper series, curette series, endplate scraper series, and osteotome series.
case_images: PMC9491466_02
case_images: Cross section (A) and sagittal (B) T2-weighted MRI demonstrated destruction at the L4/5 intervertebral space, and a huge abscess formation at the paravertebral (red arrow). The location of the working channel was planned before the operation (C), the abscess and L4/5; the intervertebral disc tissue was removed during operation (D, E). Endoscopic view of the procedure, peritoneum (white arrow), psoas muscle (blue arrow), and abscess (green circle) (E). Twenty-eight months after operation, x-ray showed a good internal fixation position and fusion of L4/5 intervertebral (F).
case_images: fsurg-09-930536-g004.jpg
case_images: PMC9491466_02_fsurg-09-930536-g004.jpg
case_images: F4
case_images: A lumbar spine MRI scan revealed infectious lesions in the L4/5 vertebral body, intervertebral disc, and surrounding soft tissues (Figures 4A,B). The D-point was made at L4/5 for auxiliary tools (Figure 4C). Abscess and L4/5 disc tissue were removed intraoperatively (Figures 4D,E). Lumbar x-ray 28 months after surgery showed a good internal fixation position and fusion of the L4/5 intervertebral space (Figure 4F).