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Science Robotics · 2026

A minimally invasive robotic spinal surgical system for anterior lumbar nerve decompression

Qingxiang Zhao1, Xiandi Wang2, Xin Zhong1, Runfeng Zhu1, Peizhi Zhou3, Dan Pu2, Baitao Lin1, Tao Li1, Shiyuan Sui1, Haonan Zhou1, Yuxi Cheng1, Hao Zheng4, Henry K. Chu4, Jiancheng Zeng5, and Kang Li1,6

1 West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China.
2 Medical Simulation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
3 Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China.
4 Department of Mechanical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.
5 Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.
6 Sichuan University-Pittsburgh Institute, Sichuan University, Chengdu 610041, China.
Sci. Robot. 11, eadu0590 DOI: 10.1126/scirobotics.adu0590 Published May 2026
Paper PDF Supplementary Materials Watch Movies DOI
Movie S3 highlights arm-arm coordination and key decompression procedures.

Abstract

Lumbar degenerative diseases, primarily caused by pathological tissues compressing spinal nerves, typically necessitate surgical intervention—specifically lumbar nerve decompression—to alleviate pain. Although the anterior decompression approach demonstrates notable advantages, such as reduced bleeding and shorter postoperative hospitalization stays, compared with the conventional posterior approach, patients may still experience incomplete decompression because of various instrumental shortcomings, including restricted visibility and insufficiency of distal dexterity. In this study, we present a robotic surgical system for minimally invasive anterior lumbar nerve decompression, which comprises three slender robotic arms (2 millimeters in outer diameter) with high dexterity (18 degrees of freedom), facilitating effective navigation through the narrow intervertebral disc space to reach the posterior area. Each robot arm is based on concentric push-pull robot structure, forming three robotized instruments: an endoscope for visualization, a laser optical fiber for hemostasis and resection, and a gripper for tissue manipulation. These components are integrated through the hollow lumen of a slender trocar, and multi-instrument coordination enables effective decompression procedure with wide view. System performance was first validated using a three-dimensional–printed vertebral phantom model to confirm accessibility to bilateral articular processes. Subsequently, in vivo animal experiment and human cadaver tests were conducted to further demonstrate the full capabilities in performing minimally invasive lumbar nerve decompression. This study demonstrates the potential of the robotic system to facilitate surgical procedures in narrow, confined, and tortuous anatomical spaces, addressing the key limitations of conventional instruments in anterior lumbar nerve decompression.

System Highlights

Surgical application

Minimally invasive anterior lumbar nerve decompression

The robotic system supports anterior access while extending dexterous decompression toward posterior spinal regions that are difficult to reach with conventional tools.

2 mm

Slender robotic arms

Three compact robotic arms are designed to reach the posterior area through the narrow intervertebral disc space.

18 DoF

Dexterous navigation

Concentric push-pull robot structures provide the dexterity needed for confined, tortuous surgical access.

3 tools

Coordinated instruments

An endoscope, laser optical fiber, and gripper work together for visualization, tissue handling, hemostasis, and resection.

Contents

Figure 1. Robotic system designed for minimally invasive anterior lumbar nerve decompression.
Robotic system designed for minimally invasive anterior lumbar nerve decompression. (A) Bedside robot. The robotized instruments and actuation unit are mounted on a rigid robotic arm. (B) Surgeon control console. Surgeons manipulate two joysticks to control instruments, with endoscopic views displayed on screens. (C) Actuation unit for the instruments and the guiding trocar, supporting rapid instrument component release and assembly. (D) Steerable sections of instruments and the guiding trocar, featuring six specialized channels for instruments and saline circulation. (E) Detached instrument components and actuation components. (F) Steerable segments of the dual-segment architecture. (G) Tenon-mortise slits of the steerable segment. (H) Passive compliant section featuring "I"-shaped slits. (I) Schematic representation of the CPPR-based steerable segment. Each segment is formed by two concentric hollow steel tubes, facilitating the integration of a secondary segment or tip tool; this dual-segment design provides enhanced dexterity and an expanded operational workspace.
Figure 4. Robot-assisted surgical protocol for anterior minimally invasive decompression.
Robot-assisted surgical protocol for anterior minimally invasive decompression. (A) The trocar is advanced through the anatomical corridor connecting the incision port to the vertebral body. (B) Initial limited visualization of the vertebra after the establishment of the surgical corridor. (C) Resection of the intervertebral disc by the thulium laser fiber, exposing the posterior spinal area. (D) Saline irrigation of the surgical site to facilitate laser resection and maintain endoscopic camera clarity. (E) Simultaneous deployment of the three robotic instruments at the right posterior spinal region for osteophyte resection. (F) Precise instrumentation control enabling access to the left posterior area, allowing for the treatment of central posterior stenosis. (G) Nerve root retraction using the gripper to mitigate the risk of iatrogenic injury during decompression. (H) Successful retrieval of resected degenerative tissue by the gripper. (I) Manual implantation of the fusion cage to restore spinal stability after the decompression procedure.

Validation

Vertebral phantom

System reachability and access to bilateral articular processes were evaluated using a three-dimensional printed vertebral phantom model.

In vivo animal experiment

The robotic instruments were tested in a porcine spine experiment to demonstrate access through the intervertebral disc.

Human cadaver tests

Cadaver experiments demonstrated key decompression procedures from the endoscopic camera perspective.

Supplementary Movies

Movie S1 · Basics of the robot system

Instrument assembly, quick exchange, single-arm motion, and multi-arm coordination.

Movie S2 · Performance of a single robot arm

Path-following behavior of a dual-segment robot arm and its load-carrying capability.

Movie S3 · Arm-arm coordination

Coordinated manipulation and an animation of key decompression procedures using endoscopic visual feedback.

Movie S4 · In vivo animal experiment

Robotic instruments incise the intervertebral disc of a porcine spine and reach the posterior area.

Movie S5 · Human cadaver tests

Endoscopic camera videos show key procedures of decompression in a cadaver.

Resources

Paper PDF Publisher version of the Science Robotics article.
Open PDF
Supplementary Materials Results, supplementary tables, figures, and movie legends.
Open PDF
Movies S1 to S5 Individual MP4 files are embedded above. A complete archive is included when hosted with the page.
Download ZIP

Citation

@article{Zhao2026RoboticSpinalSystem,
  title   = {A minimally invasive robotic spinal surgical system for anterior lumbar nerve decompression},
  author  = {Zhao, Qingxiang and Wang, Xiandi and Zhong, Xin and Zhu, Runfeng and Zhou, Peizhi and Pu, Dan and Lin, Baitao and Li, Tao and Sui, Shiyuan and Zhou, Haonan and Cheng, Yuxi and Zheng, Hao and Chu, Henry K. and Zeng, Jiancheng and Li, Kang},
  journal = {Science Robotics},
  volume  = {11},
  number  = {114},
  pages   = {eadu0590},
  year    = {2026},
  doi     = {10.1126/scirobotics.adu0590}
}