One of the biggest trends across orthopedics is using automation and robotics to guide the surgeon during surgical procedures. Mazor Robotics, the manufacturer of SpineAssist, has developed one of the only products currently available in the United States to provide spine surgeons with robotic guidance for implantable devices during spine surgery. Ori Hadomi, CEO of Mazor, and Isador Lieberman, MD, a spine surgeon with Texas Back Institute in Plano, discuss how the technology works, its benefits, common misconceptions and the future of robotics in spine surgery.
Robotic technology can facilitate spine surgery by promoting efficiency and precision with implant placement. First, the surgeon preplans the procedure using the technology and imaging from the patient's specific anatomy. Then, when the time for surgery arrives, the technology is used to help guide the surgeons to accurate place implants. "I know exactly where I want to be in the three-dimensional space and I can implant the device without having to guess," says Dr. Lieberman. Surgeons can use the technology to perform any type of implantable procedure, whether they are using an anterior or posterior approach to a single- or multi-level surgery.
As with any new technology, there is extensive training involved to learn the appropriate use of robotic guidance systems. Surgeons interested in incorporating this technology can go to didactic lectures, surgery observations and hands-on workshops to gain knowledge and experience with the technology. The training also includes cadaver labs, and clinical engineers can be available at the first few cases to make sure the surgeons are appropriately operating the system.
1. Implantations become more accurate. In a recent study published in Spine, an independent entity studied whether robotic technology was beneficial for spine surgeons. The researchers examined cases of 840 patients and found the system produced a 98.57 percent accuracy in placing implants. Another study conducted by a surgeon at Atlantic Children Hospital used the technology in 90 cases of scoliosis where he placed 1,200 implants and reported 99 percent accuracy. "For us, this is a very positive and strong statement about the system's stability and clinical ability," says Mr. Hadomi.
2. Promotes efficiency. Robotic guidance promotes efficiency during the surgery because the surgeon already has a roadmap for the patient's specific procedure. Additionally, the increased accuracy from the implants improves the patient's outcome, which means less complications and future revisions.
3. Less radiation exposure. Exposure to radiation during spine surgery is a big concern for surgeons and patients. According to an independent study published in Spine, surgeons performing minimally invasive lumbar microdiscectomies are exposed to more radiation than those performing the open procedure. However, radiation exposure isn't an issue when using robotic technology for implant placement. "When you use SpineAssist, you need very little X-ray exposure," says Mr. Hadomi.
4. Surgeons can perform complex cases minimally invasively. The robotic technology allows surgeons to perform minimally invasive spine surgery in complex cases where they might otherwise perform a large open procedure. Based on previous data taken from market surveys and report, it has been found that 10 percent of spine cases are done through a minimally invasive approach. However, in a recent paper published in Spine, a group of 14 surgeons published their results from 840 cases and revealed that about 50 percent of these cases are being done percutaneously. SpineAssist is one platform that enables more surgeons to practice minimally invasive surgery in addition to offering a safer alternative due to the decreased radiation exposure during surgery.
5. Robot is performing surgery. One of the most common misconceptions about robotic technology in orthopedic and spine surgery is that the robot is performing surgery. In fact, the robot's role during the procedure is to provide the surgeons with implantation guidance according to the surgeon's pre-mapped plan. "The robot doesn't do the surgery, it facilitates the surgical plan," says Dr. Lieberman.
In rare cases, the surgeon might need to deviate from the pre-planned surgery, which is something the robotic technology doesn't understand. Dr. Lieberman does a great deal of tumor and complex deformity work, which are some of the toughest surgeries for accurate screw placement. "A few times we've had to deviate from the preoperative plan, but at least I know where my baseline is," says Dr. Lieberman.
6. Robotic technology will make a bad surgeon good. Some surgeons might think robotic technology helps bad surgeons become good, but in reality it can do very little for surgeons who don't understand the anatomy or limitations of a procedure. The surgeon must be experienced and knowledgeable during the preplanning stages to create the best outcomes. "If you aren't paying attention, if you haven't set the perimeters correctly, you are going to run into trouble," says Dr. Lieberman. "The robot isn't going to make a bad surgeon good. What it will do is make the good surgeon more precise and efficient."
If the surgery does have a negative outcome, the surgeon may be inclined to blame the technology when the real problem might have been human error. "You have to trust the robot, but on the flip side you also have to know its limitations," says Dr. Lieberman. "It does take a little leap of faith."
7. Purchasing the technology. While many people are worried about investing in new, expensive technology, the long-term benefits of robotic surgeries, such as more efficiency and better outcomes, make the investment worthwhile. "If you look at every other industrial sector, they have all gone to automation," says Dr. Lieberman. "Medicine is going to be that way in surgery, analogous to manufacturing. As with any new technology, there is an upfront cost." Innovative hospitals will see the benefits of new technology and integrate it into their systems.
8. Targeting hospitals with a commitment to spine. SpineAssist has sold five systems in the past six months to hospitals in the United States. "We've seen a great deal of interest from the hospitals," says Mr. Hadomi. "We are focusing on working with hospitals that are committed to developing spine robotic programs." These are programs with surgeons and staff who understand and invest in their spine care, and will be able to successfully accommodate the technology.
9. Hospitals marketing the technology. Hospitals can market themselves as being on the cutting-edge spine surgery after building a program that includes robotic spine surgery. "For many years, people talked about bringing minimally invasive spine surgery to the market," says Mr. Hadomi. "This is one of the technologies that can make that happen."
10. What's in store for the technology? The robotic technology is currently in its beginning stage, says Dr. Lieberman, and in the future it stands to facilitate even more procedures, such as decompressions. "Because we have better imaging capabilities and more resources than ever before, you're going to see a lot of interesting things happen over time," he says.
Learn more about Mazor Robotics.
Read other coverage on spine surgery:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- Spine Surgery Research: 3 Areas of Focus
How the technology works
Robotic technology can facilitate spine surgery by promoting efficiency and precision with implant placement. First, the surgeon preplans the procedure using the technology and imaging from the patient's specific anatomy. Then, when the time for surgery arrives, the technology is used to help guide the surgeons to accurate place implants. "I know exactly where I want to be in the three-dimensional space and I can implant the device without having to guess," says Dr. Lieberman. Surgeons can use the technology to perform any type of implantable procedure, whether they are using an anterior or posterior approach to a single- or multi-level surgery.
Training on the technology
As with any new technology, there is extensive training involved to learn the appropriate use of robotic guidance systems. Surgeons interested in incorporating this technology can go to didactic lectures, surgery observations and hands-on workshops to gain knowledge and experience with the technology. The training also includes cadaver labs, and clinical engineers can be available at the first few cases to make sure the surgeons are appropriately operating the system.
Benefits
1. Implantations become more accurate. In a recent study published in Spine, an independent entity studied whether robotic technology was beneficial for spine surgeons. The researchers examined cases of 840 patients and found the system produced a 98.57 percent accuracy in placing implants. Another study conducted by a surgeon at Atlantic Children Hospital used the technology in 90 cases of scoliosis where he placed 1,200 implants and reported 99 percent accuracy. "For us, this is a very positive and strong statement about the system's stability and clinical ability," says Mr. Hadomi.
2. Promotes efficiency. Robotic guidance promotes efficiency during the surgery because the surgeon already has a roadmap for the patient's specific procedure. Additionally, the increased accuracy from the implants improves the patient's outcome, which means less complications and future revisions.
3. Less radiation exposure. Exposure to radiation during spine surgery is a big concern for surgeons and patients. According to an independent study published in Spine, surgeons performing minimally invasive lumbar microdiscectomies are exposed to more radiation than those performing the open procedure. However, radiation exposure isn't an issue when using robotic technology for implant placement. "When you use SpineAssist, you need very little X-ray exposure," says Mr. Hadomi.
4. Surgeons can perform complex cases minimally invasively. The robotic technology allows surgeons to perform minimally invasive spine surgery in complex cases where they might otherwise perform a large open procedure. Based on previous data taken from market surveys and report, it has been found that 10 percent of spine cases are done through a minimally invasive approach. However, in a recent paper published in Spine, a group of 14 surgeons published their results from 840 cases and revealed that about 50 percent of these cases are being done percutaneously. SpineAssist is one platform that enables more surgeons to practice minimally invasive surgery in addition to offering a safer alternative due to the decreased radiation exposure during surgery.
Misconceptions
5. Robot is performing surgery. One of the most common misconceptions about robotic technology in orthopedic and spine surgery is that the robot is performing surgery. In fact, the robot's role during the procedure is to provide the surgeons with implantation guidance according to the surgeon's pre-mapped plan. "The robot doesn't do the surgery, it facilitates the surgical plan," says Dr. Lieberman.
In rare cases, the surgeon might need to deviate from the pre-planned surgery, which is something the robotic technology doesn't understand. Dr. Lieberman does a great deal of tumor and complex deformity work, which are some of the toughest surgeries for accurate screw placement. "A few times we've had to deviate from the preoperative plan, but at least I know where my baseline is," says Dr. Lieberman.
6. Robotic technology will make a bad surgeon good. Some surgeons might think robotic technology helps bad surgeons become good, but in reality it can do very little for surgeons who don't understand the anatomy or limitations of a procedure. The surgeon must be experienced and knowledgeable during the preplanning stages to create the best outcomes. "If you aren't paying attention, if you haven't set the perimeters correctly, you are going to run into trouble," says Dr. Lieberman. "The robot isn't going to make a bad surgeon good. What it will do is make the good surgeon more precise and efficient."
If the surgery does have a negative outcome, the surgeon may be inclined to blame the technology when the real problem might have been human error. "You have to trust the robot, but on the flip side you also have to know its limitations," says Dr. Lieberman. "It does take a little leap of faith."
Future
7. Purchasing the technology. While many people are worried about investing in new, expensive technology, the long-term benefits of robotic surgeries, such as more efficiency and better outcomes, make the investment worthwhile. "If you look at every other industrial sector, they have all gone to automation," says Dr. Lieberman. "Medicine is going to be that way in surgery, analogous to manufacturing. As with any new technology, there is an upfront cost." Innovative hospitals will see the benefits of new technology and integrate it into their systems.
8. Targeting hospitals with a commitment to spine. SpineAssist has sold five systems in the past six months to hospitals in the United States. "We've seen a great deal of interest from the hospitals," says Mr. Hadomi. "We are focusing on working with hospitals that are committed to developing spine robotic programs." These are programs with surgeons and staff who understand and invest in their spine care, and will be able to successfully accommodate the technology.
9. Hospitals marketing the technology. Hospitals can market themselves as being on the cutting-edge spine surgery after building a program that includes robotic spine surgery. "For many years, people talked about bringing minimally invasive spine surgery to the market," says Mr. Hadomi. "This is one of the technologies that can make that happen."
10. What's in store for the technology? The robotic technology is currently in its beginning stage, says Dr. Lieberman, and in the future it stands to facilitate even more procedures, such as decompressions. "Because we have better imaging capabilities and more resources than ever before, you're going to see a lot of interesting things happen over time," he says.
Learn more about Mazor Robotics.
Read other coverage on spine surgery:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- Spine Surgery Research: 3 Areas of Focus