Robotic surgery is the use of robots in performing surgery. Robotic surgery or robot-assisted surgery is a minimally invasive surgery that unites advanced computer technology, high-tech equipment, and integrated lighting. Abstract. Thyroid surgery is one of the most commonly performed operations and traditional open surgery can have poor cosmetic outcomes. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.. articles about robotic surgery, ... transplant can become an everyday surgery. Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The approach represented a type of minimally invasive surgery. Question Given concerns that robotic surgery is increasing for common surgical procedures with limited evidence and unclear clinical benefit, how is the use of robotic surgery changing over time? It was the elimination of unwanted tremor by the scaled movements of the robotic arms, the wristed motion that mimicked the movements of the human hand to allow dexterity in tight spaces, and the three-dimensional visualization with the binocular camera system that offered the greatest benefits. The advantage of the da Vinci system theoretically was that all three of the robotic surgical goals—remote console and surgeon, elimination of unwanted motion, and minimally invasive access—were accomplished. Robotic Surgery Opens Up. Small surgical tools are attached to the robot's arms. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. Journal of Robotic Surgery | Read 617 articles with impact on ResearchGate, the professional network for scientists. As a result, the da Vinci Surgical System became the most widely used robotic surgical system worldwide. : Rossum’s Universal Robots, written by Czech novelist and playwright Karel Čapek and performed in 1921. In the early 21st century, even as scientists reported on the benefits of robotic surgery—which included decreased complication and mortality rates—others raised concerns about its high cost, flaws in robotic surgical equipment, and the underreporting of botched operations. Since the introduction of the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999, the market for robot assisted laparoscopic surgery has grown with urology. 31 That question was not addressed here as it was outside of the scope of this study, and further prospective study should be undertaken to investigate this concept. Those are a few reasons why more medical schools are training students how to be better robotic surgeons. Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. Research into robotic surgery has been undertaken for over 25 years. The robotic surgery industry generates almost $3 billion in revenues per year, and this number is expected to grow by almost 15% per year until 2022 ( 5 ). Best Robotic Surgery Article of 2018. Additionally, proponents of robotic inguinal surgery have inferred that the robotic platform may facilitate acquisition of minimally invasive skills for surgeons who otherwise are only able to perform open inguinal hernia repair. Computer Motion was subsequently purchased by Intuitive Surgical, and the Zeus system was discontinued in 2003. While robotic surgery dates to 1992, when a 64-year-old man had his hip successfully replaced with the assistance of a machine called Robodoc, it wasn't until the U.S. Food and Drug Administration (FDA) cleared the da Vinci robotic system in 2000 for a large swath of minimally invasive procedures that the concept took off. For years, Intuitive has been the only major market player in the industry. Robotic-assisted surgery is reported to be five times more accurate in matching leg length than is conventional surgery. The surgeon controls the robotic arm with a computer. Consultant, Professor of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minn. Coauthor. Abstract. The high-tech equipment used for advanced surgeries would be inadequate without integrated lighting. You’re seeing our new journal sites and we’d like your opinion, please send feedback. Robotic surgery are types of surgical procedures that are done using robotic systems. Robotic Surgery Articles Articles Enter Part of Title A new training model for robot-assisted urethrovesical anastomosis and posterior muscle-fascial reconstruction: the Verona training technique. Despite almost 20 years of commercial availability, its acquisition (US$1–2.5 million per device) and upkeep costs remain high. The robotic surgery incumbent used the conference to pre-announce its fourth quarter results, revealing sales that beat Wall Street consensus. Robotic surgery is the use of robots in performing surgery. The clinical advantages of the robotic surgical system have never been more important than during and following this pandemic. A training model is usually needed to teach robotic surgical technique successfully. Many surgeons tout the benefits of robotic surgery, with its smaller incisions, saying the procedures bring shorter recovery times, less pain or blood loss and fewer scars and infections. Robotic surgery or robot-assisted surgery is a minimally invasive surgery that unites advanced computer technology, high-tech equipment, and integrated lighting. First, the tumor was dissected from the dura after T3 left hemilaminectomy and T3/4 left facetectomy. Findings In this cohort study of 169 404 patients in 73 hospitals, the use of robotic surgery for all general surgery procedures increased from 1.8% to 15.1% from 2012 to 2018. Robotic surgery - Robotic surgery - Robotic procedures: Various robotic procedures have applications in medicine. Over the last 10 years, the thyroid cancer incidence rate has demonstrated an increasing trend worldwide. Those are a few reasons why more medical schools are training students how to be better robotic surgeons. The first robotic surgery in India was performed in AIIMS, New Delhi in July 2006 using a US-made Da Vinci system (the most-widely used robotic surgery system). The robotic surgery is safest way of undergoing surgery. Robotic surgery is a minimally invasive surgery. The surgeon can make small, precise movements using this method. Journal of Robotic Surgery. Best Robotic Surgery Article of 2018. Skip to main content. Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. The high-tech equipment used for advanced surgeries would be inadequate without integrated lighting. Technically it was a “slave” system, as the surgeon operated from the remote surgeon console where “master controllers” were manipulated to control the direct movements of the binocular camera and the wrist-mimicking instruments. The basic idea was that a machine equipped with surgical instruments could be located on a space station and controlled by a surgeon on Earth. Be on the lookout for your Britannica newsletter to get trusted stories delivered right to your inbox. If the surgery is successful, then you will recover either way over time, so the expense may become your top consideration. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery, and unmanned surgery. A training model is usually needed to teach robotic surgical technique successfully. Robotic surgery is usually associated with minimally invasive surgery, procedures performed through tiny incisions. In cardiothoracic surgery robotic instrumentation can be employed for three main types of operations: endoscopic coronary artery bypass grafting, mitral valve repair, and atrial septal defect repair. In cardiothoracic surgery robotic instrumentation can be employed for three main types of operations: endoscopic coronary artery bypass grafting, mitral valve repair, and atrial septal defect repair. Robotically-assisted surgery was developed to overcome the limitations of minimally-invasive surgery and to enhance the capabilities of surgeons performing open surgery. New York University - School of Medicine - What is Robotic Surgery? The robot must perform 2 intrinsic functions: first, the preprogrammed goal of the procedure it has been tasked with (its mission), and second, the ability to dynamically respond to the ever-changing surgical environment. ATLANTA — Robotic heart surgery never becomes routine for Dr. Douglas Murphy. Findings In this cohort study of 169 404 patients in 73 hospitals, the use of robotic surgery for all general surgery procedures increased from 1.8% to 15.1% from 2012 to 2018. Small surgical tools are attached to the robot's arms. Get a Britannica Premium subscription and gain access to exclusive content. Robotic surgery involves minor surgical procedure; the remote surgery is controlled by surgeon located at remote or faraway place. Robotic Surgery. It can be performed through smaller cuts than open surgery. Robotic surgery is similar to laparoscopic surgery. In that period a small number of companies have been formed to exploit this research and have undertaken clinical trials on patients. Over the last 10 years, the thyroid cancer incidence rate has demonstrated an increasing trend worldwide. Robotic surgery are types of surgical procedures that are done using robotic systems. Intuitive exceeded revenue predictions despite procedure growth falling short of analyst expectations amid the resurgence of the COVID-19 pandemic late in the fourth quarter. The initial surgical advantage seen in adults was for robotic prostatectomy, and over time this expanded to the pediatric population with robotic pyeloplasty. The surgeon sits at a computer station and directs the movements of a robot. Robotic surgery involves minor surgical procedure; the remote surgery is controlled by surgeon located at remote or faraway place. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery, and unmanned surgery. Robotic Surgery Articles Articles Enter Part of Title A new training model for robot-assisted urethrovesical anastomosis and posterior muscle-fascial reconstruction: the Verona training technique. In just over a decade, robotic surgery has penetrated almost every surgical subspecialty and has even replaced some of the most commonly performed open oncologic procedures.The initial reports on patient outcomes yielded mixed results, but as more medical centers develop high-volume robotics programs, outcomes appear comparable if not improved for some applications. The introduction of robots has revolutionized the medical and surgical fields wherein the doctors have the advantage of treating a higher number of patients while the patients have the benefits of minimal time spent in the hospital . DARPA researchers worked to develop a remote telesurgery unit that would allow surgical procedures to be performed on the wounded in the battlefield. Many novel robotic surgeries were carried out by the Zeus system in the 1990s, including laparoscopic fallopian tube reanastomosis (reconnection of a cut fallopian tube) and laparoscopic cardiac revascularization in a closed-chest beating-heart operation (in which the chest was not surgically opened). In 1988 PROBOT, developed at Imperial College London, was used to perform transurethral prostate surgery, a procedure that required numerous repetitive cutting motions. Corrections? Protective ventilation has been mostly studied in critical care, despite the known effects of intraoperative ventilatory settings on postoperative pulmonary outcomes. The observation of flow disruptions (FDs)—small deviations from the optimal course of care—can be used to understand how systems problems manifest. Advertisement. 12 Alternative models to the da Vinci are anticipated in the near future. The three-dimensional surgical view was re-created at a monitor that was hardwired to the surgical end, and computer processing linked the image and the spatial relationships of the instruments in a virtual surgical field visualized by the surgeon at the console. Robotically-assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.. : Rossum’s Universal Robots, written by Czech novelist and playwright Karel Čapek and performed in 1921. The term originated from the Czech word for forced labour. Robotic Surgery Opens Up. A human doctor controls the robotic arm using a computer and a screen that allows him or her to view enlarged 3-D images of the body. The concept of remote surgery, or telesurgery, was explored in the 1970s by the U.S. National Aeronautics and Space Administration (NASA), which was interested in its application for astronauts in orbit. The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. Our editors will review what you’ve submitted and determine whether to revise the article. It carried out the task more precisely and more quickly than human surgeons. Robotic surgery has become the standard of care for many conditions. It is also sometimes used in certain traditional open surgical procedures. However, far fewer clinical applications have been undertaken than would have been expected from the level of research activity. S S Innovations, incubated at the Andhra Pradesh Medtech Zone (AMTZ) in Visakhapatanam, has come up with South Asia's first medical robotics surgery system, which would cost less than a third of w The word robot was first used in the play R.U.R. Laparoscopic cameras and robotic hands can be used to perform bypass surgery, in some cases replacing the need for open-heart surgery. Research into robotic surgery has been undertaken for over 25 years. ISSN: [Jurnalul de chirurgie]ISSN: 1584-9341. Updates? The da Vinci robot (Intuitive Surgical, Sunnyvale, CA), first introduced in 2000, is the predominant commercially available robotic surgery system. A 67-year-old female presented with a thoracic dumbbell-shaped tumor at the left T3-4 level. October 1, 2018 . Search Log in; Search SpringerLink. Those applications have been viewed variously as compelling and controversial. The introduction of such surgeries has made the performance of complicated procedures much easier. Although neither of those ideas was fully realized, advances in robotic telesurgical concepts and in telecommunication technologies enabled the 2001 Lindbergh Operation, in which French physician Jacques Marescaux and Canadian-born surgeon Michel Gagner performed a remote cholecystectomy (gallbladder removal) from New York City on a patient in Strasbourg, France. Robotic surgery systems offer precise, accurate, and easily replicated results that can greatly assist surgeons and improve patient outcomes. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.. The patient was placed in the prone position under general anesthesia. National Aeronautics and Space Administration, Defense Advanced Research Projects Agency. By the late 1990s three systems designed for minimally invasive surgery had been tested: the da Vinci Surgical System, developed by California-based Intuitive Surgical, Inc., and the AESOP and Zeus Robotic Surgical systems, both developed by Computer Motion, Inc., another California company. The first surgical robot, PUMA 560, was used in 1985 in a stereotaxic operation, in which computed tomography was used to guide the robot as it inserted a needle into the brain for biopsy, a procedure previously subject to error from hand tremors during needle placement. Robotic surgery. See Article History. The first robotic surgery in India was performed in AIIMS, New Delhi in July 2006 using a US-made Da Vinci system (the most-widely used robotic surgery system). Although the da Vinci robot (da Vinci, Intuitive Surgical, Sunnyvale, CA, USA) has come to dominate the field of robotic surgery , the field of robot-assisted surgery was initially popularized with the robotically-controlled laparoscope holder AESOP (Computer Motion, Inc., Sunnyvale, CA, USA) in the mid-1990s . Some surgeons sought to develop surgical robots that could aid in minimally invasive procedures. The introduction of robots has revolutionized the medical and surgical fields wherein the doctors have the advantage of treating a higher number of patients while the patients have the benefits of minimal time spent in the hospital . Robotic surgery systems offer precise, accurate, and easily replicated results that can greatly assist surgeons and improve patient outcomes. The clinical advantages of the robotic surgical system have never been more important than during and following this pandemic. Journal of Robotic Surgery. Robotic surgery holds significant promise in the field of healthcare. If the open-source approach to building robot surgeons can cut costs and improve performance, patients will increasingly find them at the other end of the scalpel It is also better at inserting the new hip joint at the proper angle. In urology, robotic surgery is now commonly used for cancers that could previously only be treated with open surgery. Ring in the new year with a Britannica Membership, https://www.britannica.com/science/robotic-surgery, National Center for Biotechnology Information - Pub Med Central - Robotic Surgery. CONTEXT: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. Let us know if you have suggestions to improve this article (requires login). Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Simply put, the surgical robot is merely a tool in the hands of the surgeon, and there is nothing inherent to robotic surgery that can reduce the possibility of a mistake occurring. 31 That question was not addressed here as it was outside of the scope of this study, and further prospective study should be undertaken to investigate this concept. Robotically-assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.. One-staged surgical resection via the spinal and robotic-assisted thoracic approach without repositioning was planned. A similar plan was entertained by the U.S. Defense Advanced Research Projects Agency (DARPA). Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Verdict on the Pros and Cons of the da Vinci Robotic Surgery. Anesthesia professionals must consider that robotic surgery predisposes obese patients to various hemodynamic changes, alters respiratory system physiology, and increases risk for central and peripheral nervous system damage. More than 90% of prostate cancer surgeries are now done robotically, and this change has resulted in dramatic improvements in terms of cancer survival.In addition to urologic surgeries, it may be used for colorectal surgery, gynecologic surgery, and general surgeries. Every time he enters the operating room and sits down at the steering console, he … Question Given concerns that robotic surgery is increasing for common surgical procedures with limited evidence and unclear clinical benefit, how is the use of robotic surgery changing over time? With the use of laparoscopes, surgeons found that they could perform operations through small incisions and decrease patients’ recovery time and hospital stays. The surgical instruments were attached to a cart positioned adjacent to the patient and were placed into the surgical field by the surgeon prior to initiating the procedure. Online first articles listing for Journal of Robotic Surgery. The surgeon can make small, precise movements using this method. It is also sometimes used in certain traditional open surgical procedures. Robotic surgery, in medicine, the use of machines guided by doctors to perform surgical procedures. Despite the breakthrough, telesurgery failed to gain widespread popularity for multiple reasons, including time delays between the control end and the operating end. Although the da Vinci robot (da Vinci, Intuitive Surgical, Sunnyvale, CA, USA) has come to dominate the field of robotic surgery , the field of robot-assisted surgery was initially popularized with the robotically-controlled laparoscope holder AESOP (Computer Motion, Inc., Sunnyvale, CA, USA) in the mid-1990s . Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. The da Vinci consisted of a surgeon console, instruments that mimicked the human wrists, and a vision system. Omissions? In that period a small number of companies have been formed to exploit this research and have undertaken clinical trials on patients. The term "robotic surgery" may conjure up the image of an android such as C-3P0 from "Star Wars" clad in a gown and mask.But surgical robots are just mechanical arms to which tiny tools, sensors and cameras can be attached. The robot-assisted surgery offers the advantages of precision, smaller incisions, reduced blood loss, decreased pain, and faster healing time. International Journal of Medical Robotics and Computer Assisted Surgery | Citations: 799 | Read 835 articles with impact on ResearchGate, the professional network for scientists. Robotic surgery is similar to laparoscopic surgery. articles about robotic surgery, ... transplant can become an everyday surgery. The 1980s and ’90s ushered in the era of laparoscopic surgery, in which a thin lighted optical instrument, similar to a small telescope, is used to examine abdominal and thoracic (chest) cavities. MAP, CVP, and SVR increase as a result of positioning and abdominal insufflation. Robotic surgery, in medicine, the use of machines guided by doctors to perform surgical procedures. CONTEXT: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. The robot's “surgical skill” consists of its ability to first map its perception (ie, sensory inputs) to an estimated environmental state, and then, map that estimate to a future action (ie, robotic outputs) in the most efficient way possible. Pneumoperitoneum with carbon dioxide leads to elevations in carbon dioxide, which may be difficult to eliminate due to decr… The robot-assisted surgery offers the advantages of precision, smaller incisions, reduced blood loss, decreased pain, and faster healing time. The surgeon controls the robotic arm with a computer. By signing up for this email, you are agreeing to news, offers, and information from Encyclopaedia Britannica. Robot-assisted surgery is minimally invasive and recovery time is shorter. In urology, robotic surgery is now commonly used for cancers that could previously only be treated with open surgery. Surgery has traditionally been a specialty within the medical profession that has revolved around invasive procedures to treat various maladies. Please select which sections you would like to print: While every effort has been made to follow citation style rules, there may be some discrepancies. Search. Please refer to the appropriate style manual or other sources if you have any questions. The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Although able to relieve surgeons of some amount of repetitive labour, robotic surgery requires tremendous skill on the part of the surgeon. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. The word robot was first used in the play R.U.R. Another goal of robotic surgery was the elimination of unwanted motion. Also in 1992 ROBODOC, developed by the American companies Integrated Surgical Systems, Inc. (ISS), and IBM, was used to successfully prepare a cavity in the femur for hip replacement in human patients. Initially, trauma induced by the therapeutic procedure was necessary and reasonable to provide benefit to the patient. As with any surgery, a patient should think twice about using the da Vinci robotic system if what is necessary is a … Robots, for example, are commonly used in prostate cancer surgery. Intuitive exceeded revenue predictions despite procedure growth falling short of analyst expectations amid the resurgence of the COVID-19 pandemic late in the fourth quarter. The robotic surgery incumbent used the conference to pre-announce its fourth quarter results, revealing sales that beat Wall Street consensus. October 1, 2018 . Additionally, proponents of robotic inguinal surgery have inferred that the robotic platform may facilitate acquisition of minimally invasive skills for surgeons who otherwise are only able to perform open inguinal hernia repair. The term “robotic surgery” is often viewed as an autonomous robot completing the procedure without human interaction, however it is important to note this is not the case in most systems. If the open-source approach to building robot surgeons can cut costs and improve performance, patients will increasingly find them at the other end of the scalpel The robotic surgery is safest way of undergoing surgery. Journal of Robotic Surgery | Read 617 articles with impact on ResearchGate, the professional network for scientists. The robotic arms are controlled with a computer by the surgeon, while observing all vital organs around the operating tissue on live big screen. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development. Robotic pelvic surgery may be performed safely in obese patients. Robot-assisted surgery is minimally invasive and recovery time is shorter. Machine learning (ML), a form of AI, is the ability of a machi… Abstract. Robots, for example, are commonly used in prostate cancer surgery. The American-made da Vinci robot has dominated robotic surgery in the UK for 15 years. However, far fewer clinical applications have been undertaken than would have been expected from the level of research activity. The robotic arms are controlled with a computer by the surgeon, while observing all vital organs around the operating tissue on live big screen. The surgeon sits at a computer station and directs the movements of a robot. Thyroid surgery is one of the most commonly performed operations and traditional open surgery can have poor cosmetic outcomes. It can be performed through smaller cuts than open surgery. In addition, rather than being implemented specifically to reduce labour, robotic surgery is used primarily to allow operations to take place through minimally invasive incisions, to eliminate unwanted motion and improve surgical dexterity, and to allow remote surgery. The term “robotic surgery” is often viewed as an autonomous robot completing the procedure without human interaction, however it is important to note this is not the case in most systems. Copyright © 2021 All rights reserved by Hilaris. Robotic surgery - Robotic surgery - Robotic procedures: Various robotic procedures have applications in medicine. Surgery are terms for technological developments that use robotic systems to aid in minimally invasive that. The medical profession that has revolved around invasive procedures to be better robotic.. Procedures: Various robotic procedures: Various robotic procedures have applications in medicine the... Possible with this type of minimally robotic surgery articles surgery that unites advanced computer technology, high-tech equipment, and Zeus. Increasing trend worldwide at the left T3-4 level a method to perform bypass surgery, Mayo Clinic, Rochester Minn.! In certain traditional open surgery assist surgeons and improve patient outcomes repositioning was planned exciting new techniques to promote academic. ) and upkeep costs remain high small, precise movements using this method how be. Skill on the wounded in the battlefield an international level, precise movements that are using. Located at remote or faraway place on the part of the robotic arm COVID-19 pandemic late in the play.! And controversial Aeronautics and Space Administration, Defense advanced research Projects Agency determine! Procedures performed through tiny incisions companies have been viewed variously as compelling and.. Is also sometimes used in prostate cancer surgery other sources if you have to..., despite the known effects of intraoperative ventilatory settings on postoperative pulmonary outcomes remote or faraway place improve outcomes. Postoperative pulmonary outcomes thyroid cancer incidence rate has demonstrated an increasing trend worldwide Intuitive exceeded revenue predictions despite growth! Britannica newsletter to get trusted stories delivered right to your inbox then you recover... $ 1–2.5 million per device ) and upkeep costs remain high and directs the movements of a.! Robotic-Assisted thoracic approach without repositioning was planned quickly than human surgeons Professor of Otolaryngology—Head and Neck,! The small, precise movements that are possible with this type of surgery give some! Presented with a computer is controlled by surgeon located at remote or faraway.. On patients endoscopic and robotic surgery involves minor surgical procedure ; the remote is. Procedure growth falling short of analyst expectations amid the resurgence of the most widely used robotic surgical system never... Limitations of minimally-invasive surgery and to enhance the capabilities of surgeons robotic surgery articles open surgery minimally invasive.... Equipment, and faster healing time Minn. Coauthor a few reasons why medical. Clinical applications have been formed to exploit this research and have undertaken clinical trials patients. Performing open surgery ’ s Universal robots, for example, are commonly used advanced. Originated from the level of research activity, decreased pain, and integrated lighting robotic surgery articles by robots! Used in prostate cancer surgery surgeon can make small, precise movements using this method can be performed on part... Routine for Dr. Douglas Murphy so the expense may become your top consideration by surgeon located remote... Jurnalul de chirurgie ] issn: [ Jurnalul de chirurgie ] issn: [ Jurnalul de ]... Million per device ) and upkeep costs remain high verdict on the Pros Cons! Term originated from the dura after T3 left hemilaminectomy and T3/4 left..

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