Robotic-assisted surgery has moved past the novelty stage in orthopedics, and one of the field’s earliest adopters says the technology’s biggest wins are still ahead — both in what it can prove and in who it can help.
Hafiz Kassam, MD, director of the shoulder reconstruction division of Hoag Orthopedic Institute in Irvine, Calif., was among the first surgeons in the world to use Zimmer Biomet’s ROSA robotic system for shoulder replacement.
Dr. Kassam recently connected with Becker’s to discuss the benefits he expects robotic assistance to deliver, the outcome metrics that will prove it out and where he sees the broader field of surgical robotics and enabling technology heading over the next decade.
Note: Responses have been lightly edited for length and clarity.
Question: What is the biggest benefit you expect robotic assistance to deliver?
Dr. Hafiz Kassam: I think the real value is that most shoulder replacements in this country are done by surgeons who do far fewer cases a year. The question is whether this technology can bring the outcomes of a surgeon who does 20 surgeries a year closer to one who does 80 or 90. That’s a meaningful benefit not just for that surgeon, but for patients in communities that don’t have access to high-volume surgeons. Raising that baseline, across the board, is where I think the real upside is.
Q: What metrics will demonstrate that this technology is delivering better patient outcomes?
HK: The first is placement — did the implant go in the position you planned, and how much variance was there compared to doing it by hand? That’s measurable right away. Over time, you also track whether that translates clinically: fewer complications, better longevity, fewer revisions. We’re just getting to the five- or six-year mark for hips and knees, so those outcome studies are starting to come out, and they’re encouraging. For shoulders, it’ll take a few more years, but the framework for proving it out is already there.
Q: Where do you see robotics heading over the next five to 10 years?
HK: Like most technology, it’ll get smaller, cheaper and more accurate. I think this is basically the first iPhone, and over the next decade, the footprint will shrink, the technology will improve and there will be more capability built in with each iteration. I don’t think we’ll see full autonomy in the next 10 years, but you’ll see more assistive capability layered in once this current wave proves itself: consistent, accurate and cost-effective. The bigger opportunity I’m excited about is whether we can use that progress to help the profession broadly by improving access for patients and outcomes for surgeons who don’t operate at high volume, not just making the technology flashier.
Q: Are there any other new orthopedic technologies that you are excited about?
HK: In the next few months, I will also start evaluating and utilizing one of the newest mixed reality systems in shoulder arthroplasty, Signature Vision. Instead of a robot serving as the guide, you see an overlay of reference points on the shoulder and use your own hands to follow it. It’s a different way of solving the same problem — better precision without the footprint or cost of a full robotic system — and I think it opens the door for more surgeons and more sites of care to adopt this kind of precision technology sooner.
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