Wilmington, Del.-based Nemours Children’s Hospital acquired its first spine robot, and Suken Shah, MD, said it gives surgeons an advantage working with complex pediatric spine cases.
So far the robot, Velys Spine, has been used in a few cases in its first week at the hospital, and more are scheduled, Dr. Shah said. Previously Nemours has used navigation technologies, and the hospital’s surgeons are well-trained to perform freehand spine cases.
He spoke with Becker’s about how the start of the spine robotics program is going and innovations he’s watching in pediatrics.
Note: This conversation was edited for clarity and length.
Question: How did the first cases with the robot go?
Dr. Suken Shah: The first case we did was on June 10. That case was a young child, who previously had growing rod instrumentation, that was a candidate for revision to a final fusion. In that situation, you have complex and small anatomy with prior implants in place. Then some of the spine becomes spontaneously fused, and it obscures the landmarks. This case involved removal of instrumentation and placement of brand new instrumentation, and this is what we use the robot for.
The second case we did was another patient with pretty complex anatomy, and she had osteogenesis imperfecta. She’s an adult patient, and in some ways the bone was very thin and hard to penetrate with normal techniques, and so the robot gave us excellent guidance and was very helpful in cannulating those very typical pedicles.
The third patient was a patient with achondroplasia, a skeletal dysplasia that causes dwarfism. And so you can imagine, when the patient is very small the anatomy is even smaller, and this patient had a very severe kyphosis. The robot was used to place all the screws in a very complex trajectory to then prepare to do the osteotomy and bone resection.
Those cases are the most complex of the complex. And it is not our intention to just use the robot for the most complex but we put the robot to the test of whether this can handle that. I think what’s important for the learning curve is to approach standard cases with the robot, build your workflow, navigate the learning curve with those cases, and then continue to use it for more and more complex cases as well.
Q: What was your strategy to get buy-in from hospital leaders for the robot?
SS: We have a strong culture of safety and a strong culture of innovation and staying at the forefront of technology because we are a training program. It has certainly been on our mind, and with economic times as they are, you can imagine that getting capital purchases through like this is difficult. We have an executive leadership which is very willing to support positions in these endeavors. But what really was the clincher was that we had a very interested philanthropist in the area who was willing to partially support the purchase.
Question: What other innovations are you watching when it comes to pediatric spine care?
SS: Two exciting areas are growing rod technologies and vertebral body tethering. While these innovations aren’t novel, there is a growing body of evidence about which patients will be the best for these technologies, what kind of complications we might be seeing in the future, and how to better deal with those complications by prevention. We’re also learning about revision of these technologies. If tethers break or the growing rods aren’t functioning anymore, changing the technology out for a definitive fusion is something that we are excited about. So pulling multiple centers’ data through study groups and publishing those results and teaching our colleagues the best way to handle these problems is very fulfilling for us.
As far as particular technology, I think that we’re closer to augmented reality or virtual reality, being paired with some of these other enabling technologies. We still have this line of sight issue. I would rather be looking at the field when I operate freehand. I’m looking at the field and getting haptic feedback when we’re using navigation or robotic technology, and we’re looking at a screen as well as having to look at the field. If we can eliminate that line of sight issue and keep it to just the surgical field by augmenting our vision with the digital overlay that would be a real advance.
