Q: What were some of the benefits of using robotic assistance during the surgery?
Dr. Thomas Schuler: It gave us additional information on how to place the instrumentation. At the same time, surgeons must also use their own experience and knowledge to validate that the robot is not making any mistakes. Robot-guided surgery doesn’t mean that a novice surgeon can safely put in instrumentation; one must also rely on his or her surgical acumen to verify that the robot’s computations are accurate.
I see potential with robot-guided spine surgery, but it still requires a skilled surgeon to decrease the risk of a catastrophic complication. However, a skilled surgeon coupled with the technology will help advance minimally invasive surgery.
Q: What were some of the challenges in using new robot-guided technology during surgery?
TS: The robot is not infallible. It’s a tool to aid the progression of our minimally invasive surgeries, but there are limitations. In fact, we did have to adjust some things because there were –some questionable alignments chosen by the robot.
During a thoracic fusion, one of the screws breached the medial wall. In the case of a lumbar fusion, the robot, in spite of good programming, wouldn’t align with the pedicle in a way we are satisfactorily comfortable with. So we had to abandon the robot and revert to an open case to ensure a safe outcome for the patient.
In short, spine surgeons have to utilize their knowledge and skills to adjust when things aren’t right in robot-guided surgery.
Q: As a spine surgeon, what did it take for you to prepare for robot-guided surgery?
TS: Twenty years of clinical practice. It’s just an extension of what we already do. One must have an open mind to be willing to change from their routine, but in terms of skill sets, it’s really not a different skill set. It does require a willingness to evolve and a ability to visualize 3 dimensionally through the skin, both of these traits are essential to an excellent spine surgeon.
Q: Were you involved in the process of purchasing the robotics? If so, what did that process entail?
TS: HCA Reston counseled with us, but the hospital ultimately purchased the robotics. Our input was requested, but ultimately the hospital did the negotiations with Mazor.
Q: In your early years as a spine surgeon, would you have ever imagined performing robot-guided surgeries?
TS: No, I was initially surprised that the technology allowed us to do this. I think it is a great advance from that standpoint.
Q: Where do you see robot-guided spine surgery headed in the future?
TS: I think the technology will continue to evolve and allow us to do more and more less invasively. I think spine surgery could end up like arthroscopic surgery where, with a few puncture wounds, you can fix bigger issues using minimally using techniques.
The essential key to any spinal surgery is know how to be maximally effective with the least disruption of normal tissues. Robotic assistance will allow spine surgeons to advance minimally invasive surgery. It’s an asset. It’s evolution is still not complete, but the current systems are functional. Hopefully robotic guidance will get even better as the supporting technology continues to improve.
Robot-guided spine surgery will provide for faster recoveries and better overall results in the future if it’s done right. It still requires that the surgeon fulfill basic fusion essentials including adequate fusion site preparation and appropriate graft material. I’m excited to be part of this innovation.
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