Mark Schultzel, MD, is hardly a skeptic of surgical innovation. He uses augmented reality in the operating room, has helped develop minimally invasive surgical technology and believes AI could transform hospital efficiency.
But when it comes to one of orthopedics’ biggest technological investments, he is considerably less enthusiastic.
“The robot to me is not super useful yet, to be honest,” Dr. Schultzel told Becker’s.
The shoulder and elbow surgeon, who is division chief of orthopedic surgery at San Diego-based United Medical Doctors, believes the industry’s challenge is not simply developing more sophisticated technology. It is determining whether those advancements solve problems surgeons and patients actually face.
His perspective has been shaped by experiences ranging from treating Olympic athletes to developing surgical devices, all of which have reinforced his belief that progress in orthopedics should be measured by its impact on patient care rather than technological sophistication alone.
Why augmented reality has his attention
While robotics has attracted significant investment across orthopedics, Dr. Schultzel questions its current value in certain joint replacement procedures. He contrasted it with abdominal surgery, where robotic systems can enable smaller incisions and improved access, arguing that the advantages are less apparent to him in dynamic joints such as the shoulder, hip and knee.
Instead, he has gravitated toward augmented reality. Dr. Schultzel uses Apple’s Vision Pro to access CT and MRI images during surgery and give trainees a surgeon’s-eye view of procedures. The technology also reduces the need to repeatedly turn toward conventional monitors, easing strain on his neck and back.
He sees further potential in systems being developed to overlay preoperative CT imaging onto the surgical field during shoulder replacement, with the goal of improving implant positioning. That emphasis on precision extends to surgical planning. Dr. Schultzel believes digital templating should become routine in joint replacement, particularly as surgeons encounter complex anatomy.
“We have to remember, we’re dealing with people, and you don’t want to make a mistake of something that you could have prevented if you templated,” he said.
Some of the technologies he considers most promising, however, operate outside the surgical field. He pointed to AI-driven operating room optimization platforms that identify unused surgical capacity and improve coordination of staffing and equipment. By addressing inefficiencies rather than changing the procedure itself, he believes these tools could help hospitals accommodate more cases with existing resources.
The distinction reflects his broader view that the most valuable innovations are not necessarily those that change how surgeons operate, but those that address the limitations affecting care.
When a surgical limitation sparks innovation
Dr. Schultzel encountered that principle firsthand while helping develop a minimally invasive Achilles tendon repair technique.
While pursuing his MBA at the University of California San Diego, he performed an open Achilles repair on a classmate’s brother. Although he generally favors minimally invasive surgery, he had reservations about existing techniques that required passing instruments without directly visualizing the tendon or nearby sural nerve.
Around the same time, engineers in Taiwan approached him about advising a surgical technology company. When they asked which procedure could benefit from a different approach, the Achilles repair immediately came to mind.
Their collaboration led to the development of an ultrasound-guided technique intended to improve visualization during minimally invasive Achilles tendon repair. Whether the approach produces better outcomes than existing techniques would require comparative clinical evidence.
For Dr. Schultzel, the experience demonstrated how frustrations encountered in everyday practice can become starting points for innovation.
He had encountered a similar opportunity during the COVID-19 pandemic, when he helped develop a reusable, 3D-printed mask system in response to shortages of protective equipment. In both cases, the work began with an unmet need rather than a technology in search of an application.
What the Olympics taught him about recovery
Not all of Dr. Schultzel’s ideas about improving orthopedic care have come from developing technology. As a volunteer physician for Team USA, he has worked at the 2018 Winter Olympics in South Korea, and the Tokyo Olympics, and helped prepare athletes in the U.S. Olympic and Paralympic Training Center in Colorado Springs, Colo. ahead of the 2024 Paris Games.
His experiences with Olympic and Paralympic athletes exposed him to the psychological demands of rehabilitation, particularly when an injury temporarily removes an athlete from the activity central to their identity.
Dr. Schultzel believes orthopedics often overlooks the psychological toll of injury and recovery, even though addressing patients’ mental and emotional well-being is an important part of their care.
He has incorporated those lessons into his practice, occasionally referring active patients to sports psychologists and drawing on cognitive behavioral approaches and breathing techniques to help manage pain.
“Recovery from surgery is oftentimes a marathon and not a foot race,” he said. He also emphasizes preoperative nutrition, hydration and bone health, drawing on enhanced recovery protocols used in other specialties. After surgery, smartphone-based remote physical therapy allows him to monitor rehabilitation progress and identify setbacks between office visits.
The approach reflects his belief that improving outcomes requires attention to the entire surgical episode, not just what happens in the operating room. “You can’t treat everything like a hammer and a nail,” he said. “You really need to personalize it towards your patient.”
Making innovation useful
For hospitals hoping to adopt emerging technologies, Dr. Schultzel believes creating opportunities for physicians to evaluate them is an important first step.
At San Diego-based Sharp HealthCare, where Dr. Schultzel is also affiliated, he has seen how structured innovation efforts can bring clinicians together to pilot new ideas. He pointed to the system’s work in spatial computing, including initiatives involving ophthalmologist Tommy Korn, MD, as an example of physician-led experimentation.
For organizations without dedicated innovation programs, he suggested forming committees of interested surgeons to review and test promising products before committing to broader adoption.
“I call it kicking the tires and seeing if it’s going to work for you,” he said.
For hospitals weighing investments in robotics, AI and other technologies, his advice is to start with the problem, not the product. The next breakthrough in orthopedic care may not be the most sophisticated technology, but the one that solves a problem worth solving.
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.
