Some spine surgeons change tune on navigation, robotics


The development of spine robots and navigation comes with the promise of improved precision and efficiency, beneficial to the surgeon and patient. Although the worry of overreliance looms, some spine surgeons remain optimistic about the technology's advantages.

Jason Liauw, MD, of Laguna Hills, Calif.-based Hoag Orthopedic Institute, said his outlook on enabling technologies has changed over the past decade.

"Even though I am more of a traditional freehand open spine surgeon, I think navigation and robotics will continue to evolve and create a dependency of surgeons on augmented technologies," Dr. Liauw told Becker's. "Certainly this is a different tune than I was singing 10 years ago when I started practice. Amongst the surgeons whom I work with, I already am seeing a comfort level with navigation and robotics develop that didn't exist a decade ago. … While I hate to admit it, I do believe these technologies will drive a more reproducible and consistent surgical outcome and will reduce misplaced hardware for surgeons who aren't as familiar with freehand technique." 

The robot and navigation technologies available continue to sharpen, with new iterations and softwares being added. This year alone, spine and orthopedic surgeons can expect to see multiple new robots from large medtech companies.

Some spine surgeons still choose freehand surgery over navigation, however. 

"I haven't used them at all in my own practice," Michael Kelly, MD, of Rady Children's Hospital-San Diego, told Becker's. "I'm currently faster than the machine. The moment the machine gets faster than me or I don't hear the occasional horror story about malpositioned robot screws or navigated screws, I'll switch. But I am just reluctant to change something that I don't feel is a problem for me."

But for spine surgeons who want to learn to use the new tools, a strong educational program that builds technological expertise from traditional skills first is key, according to Dr. Kelly.

"The most important for navigation when you're training is choosing a program that does both navigated and minimally invasive surgeries and a program that has a large open experience," he said. "It's much easier to know how to go from big, open insertion of crooked screws to understanding what's under the skin using a robot or navigation, than to just do it blindly always and then have to do it open. That doesn't always work. It's not an equal back and forth."

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