Robots have become central in the future of the orthopedic device market and joint replacement surgery over the last several years.
However, as these technologies become more ubiquitous, surgeons have begun questioning their true value in surgical care at a time when costs must be strictly managed across health systems, hospitals and ASCs alike.
“There still just really hasn’t been the literature to support widespread [robot] use,” Travis Doering, MD, a hand and upper extremity orthopedic surgeon in Austin, Texas, said on a panel At Becker’s 23rd annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago June 11-13.
He explained that the outcomes data simply haven’t materialized in a way that would justify the operational cost of adopting them at scale. While total knees and hips, the mechanical complexity of the procedure offers at least a theoretical case for robotic precision, Dr. Doering said that when thinking about “the efficiency in terms of the robot setup,” which includes staff training and implementation, “there hasn’t been any credible sources that robots in orthopedics as a whole is advantageous.”
Part of the problem, he added, may be structural. The outcomes most likely to differentiate robotic from traditional surgery — aseptic loosening, periprosthetic infections — are low-frequency events that even well-designed studies struggle to power adequately. “You’re never going to be able to get those to zero as much as you may want to,” Dr. Doering said. “And so, as useful as the robots are in many ways, it’s one of those things.”
Joseph Lamplot, MD, an orthopedic and sports medicine surgeon at Endeavor Health’s Northwest Community Hospital in Evanston, Ill., acknowledged the pull toward robotic adoption in shoulder arthroplasty but said the evidence pushes him toward a narrower conclusion: the value is in planning, not the robot itself.
“The literature hasn’t necessarily borne out that computer navigation or robots increases or improves outcomes,” Dr. Lamplot said. “I do think in shoulder arthroplasty, the use of some kind of guide or some kind of three-dimensional planning has improved decreasing outliers. So I think in the shoulder arthroplasty world, that has changed my practice and something I’m using regularly.”
The distinction matters. Three-dimensional preoperative planning and navigation-assisted guide placement offer discrete, measurable benefits — reducing outliers in component positioning — without the full operational overhead of a robotic system. Dr. Lamplot’s framing positions navigation as the defensible piece of the technology stack and the robot as the element still awaiting its evidence base.
Janet Carlson, MSN, RN, CEO and founder of Vertex Surgical Solutions, brought the same skepticism from the facility side. She said her first question to any vendor is whether the product was designed for hospital use and then retrofitted for the ASC setting — or whether ASC-specific constraints were considered from the start.
“Most vendors are using the hospital as their benchmark,” Ms. Carlson said. “And, obviously, I need to know if they’ve even contemplated the ASC to begin with.”
The practical implications go beyond purchase price. Robotic systems require staff training, specific vendor relationships, physical footprint and setup time — all of which affect throughput in a facility where turnover speed is a core economic variable. Ms. Carlson said she evaluates technology against a consistent framework.
“Is it, is it time neutral or not? And it’s OK to have a learning curve when we implement something new,” she said. “Is it going to help improve the throughput and the patient outcomes and the post-op recovery? Patient satisfaction, which is huge, is now being measured.”
Dr. Doering and Ms. Carlson were both enthusiastic about peripheral nerve stimulation as a near-term opportunity with a clearer evidence base and ASC-friendly economics. Dr. Lamplot also nodded to AI-assisted dictation software as a workflow tool that has meaningfully changed his daily practice — with a caveat that not all platforms deliver the same efficiency gains.
On robots specifically, the panel’s consensus position was that the technology isn’t necessarily wrong, but leaders must rigorously question its measured impact on outcomes and patient satisfaction.
“If it’s not going to help move the needle in one way into the positive and not be a drag on your throughput,” Ms. Carlson said, “then I would just think more about the actual practical use of it and not just the promise of something sophisticated.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
