The orthopedic industry has been improved with the introduction of surgical robots, but they still have a ways to go, according to two surgeons.
While robots can be helpful for surgeons, they can also cause some inefficiencies in procedures that conventional instruments don’t have.
Frank Congiusta, MD, a hip and knee specialist, and Lee Kaback, MD, an elbow and shoulder specialist, both of OrthoNY, recently connected with Becker’s to share the impact robotics has had on the orthopedic field, how it can be improved upon and the future of the technology.
Note: Responses were lightly edited for clarity and length.
Question: How has robotics changed the way that orthopedic surgeons deliver care?
Dr. Frank Congiusta: It has changed some things and not changed other things. I think robotics is still in its beginning stages. The biggest thing that’s changed in knee replacement is the way some people are aligning their knees. There’s a newer faction of knee surgeons who are doing what’s called kinematic alignment, where they don’t completely restore the patient’s normal mechanical alignment. Robotics allows you to do that because you can deviate from the way our conventional instruments made the bone cuts. At this point, we don’t know whether or not that’s any better than the old-fashioned way due to the lack of data and studies. The only thing I can tell you for sure is it makes the surgery last longer. For surgeons who do a lower volume, it may actually help to an extent, because it helps you achieve the alignment you want better.
Dr. Lee Kaback: It definitely has not been shown to improve outcomes, at least in the shoulder world, at least not yet. The shoulders are not as complex in terms of alignment kinematics as hip and knees. From the shoulder world, we feel that robots can really help our implant positioning and then in theory help us get better motion in the long run. We don’t have that data yet. I do agree that for high volume surgeons, robots will likely slow us down and potentially not increase our efficiencies. But a lot of surgeons are being trained with robots, so I think it’s a technology that I think we have to embrace and be critical of, but definitely learn from.
Q: How can efficiencies with robots be improved?
FC: When you start the surgery, you have to put in anatomical landmarks for the robot. When you use the saw to make your bone cuts, it is basing that on what information you put in in the beginning. That is the part of the surgery that slows it down a little bit, because normally we don’t have to do that. If that aspect could be made more efficient, it would help because that process takes about 10 to 15 minutes in the beginning of the procedure to do. With the conventional way, I’m sometimes almost finished with the knee replacement in 10 to 15 minutes. So I think that’s the biggest difference.
LK: The robot is only as good as you make it right. It depends on your planning, so if you’re planning is off, your robot is off. I still think that surgeons need to be in control of their surgeries and make sure the cuts are appropriate, the readings are appropriate and the depths are appropriate. If your pre-operative planning is off, then your robot is off, and that could be a problem.
Q: Where do you see robotics going forward?
FC: Part of the reason why I do robotic surgery is because I do believe it is the future. I believe that is the way it’s going to go. There are some improvements that need to be made, but there’s some really cool stuff on the horizon. One demonstration I saw had virtual reality goggles, and when you’re doing a hip replacement, you don’t see any of the soft tissue or the blood. You just see the patient’s bone and your instrument, and you could literally put it exactly where you want it. I also think AI is going to change the game tremendously. Within the next five years, I think we’re going to see a new generation of orthopedic robots that is going to achieve more accuracy combined with more efficiency, which is what we all want.
LK: I think augmented reality is going to tag on to robotics. Robotics is here to stay, at least for now, until, until something new comes along. I think we need to embrace it, because patients, quite frankly, are asking for it. The marketing is so robust with robotics that patients are asking us what robot you’re going to use for the surgery. So surgeons need to be aware of it. In the future, augmented reality is gonna be a big part of how we operate as surgeons.
