Context The lower spinal vertebrae are often repaired through an incision directly over the spine, called the posterior lumbar approach. In spinal fusion, surgeon stabilizes the back by fusing certain vertebrae together with bone grafts or metal rods. For doing the surgery in minimally invasive approaches, different tools and system are designed to allow cannulated pedicle screws to be placed appropriately in a true percutaneous fashion. However, the rod insertion still has problems and difficulties that prevent the procedure to be in minimally invasive. Purpose The purpose of this paper is to address the difficulties of the surgical tasks for rod insertion, to review the existing system and procedures for rod insertion, and to propose a new designed system that enables surgeon to insert the rod and guide it through the pedicle screws in MIS conditions. Materials and methods With the collaboration of the Hospital of Grenoble, France, the study started and some spinal fusion operation in open and minimally invasive procedure have been observed and analysed. Based on the extracted task list, a scenario for orthopaedic traumatology was prepared. The main objective for the design was to have a universal recipient rod holder (independent to the rod type), an easy load and unload system, and simple assembly after which fit with the sterilisation procedure. A first prototype have been fabricated and tested on a phantom. With some modification the second prototype have been designed and tested by surgeons on cadaver. Results The result of both ex-vivo and cadaver tests seems promising. The rod holder submitted for patent and a series of clinically approved prototypes are fabricated to be used in operations by different surgeons and Genoble Hospital to have the enough evidences for clinical validation of the instrument.