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Wed, 17 Jul 2019

Are Robots Taking Over the World?

You see robotic technology used in more and more applications daily.  There are robotic devices designed to help with tedious, dirty and dangerous chores.  With a quick search you can find robotic tools to vacuum your house, mop floors, change the litter box, clean gutters, and the list goes on.  Robotics for domestic applications have come a long way since the introduction of the clothes dryer and dishwasher – and will continue to evolve.  Which brings us to the question:

Are robots taking over the world?

The use of robotic devices to assist surgeons in the operating room is not a new concept.  Recently, Miller Orthopedic Specialists announced the use of a robotic-arm to assist with partial and total knee replacement surgeries.  In this application, the robotic device is a highly advanced tool used to create a more favorable outcome for the patient.  The Mako robotic-arm assists in carrying out a pre-operative plan, mapped out with a 3D model of the patient’s knee.  Utilizing the pre-operative 3D model allows the surgeon to customize the size and orientation for each patient.  The robotic tool is not meant to replace surgical judgment.   It is meant to assist the surgeon in maintaining a more precise margin, with less damage to soft tissues.  What this means for the patient is less pain after surgery and shorter recovery times, getting them back to their active lifestyles quicker.

As you may have seen in multiple applications, all robotics are not created equal.  Robotics have constantly evolving software and are capable of completing tasks with increased accuracy as they graduate from one generation to the next.   As the brilliant minds at iRobot will attest to, the Roomba has come a long way from its 2002 launch.  The technology has evolved, and equipment has been perfected over the last 17 years.  Here are some things you should consider about the different types of robotic devices utilized for orthopedic surgery. 

There are three types of robotic systems:

Passive systems:  These systems help the surgeon with mapping and navigation to carry out a plan created during surgery. In these systems the robotic device is assisting with positioning but not making surgical cuts.

Semi-active systems:  These systems help with mapping, navigation, providing feedback to the surgeon for precise bone cuts, and eliminating mal-positioning intra-operatively.  Some semi-active systems utilize a 3D model for pre-operative planning. “The big advantage of 3D image-based systems is you are determining your target and your plan in three dimensions in a way that could not be otherwise intra-operatively determined and then you know that you will be hitting that target with a level of accuracy that cannot be achieved without a robot, in terms of an individual cut or an individual component’s position,” David J. Jacofsky, MD, founder and CEO of CORE Institute, a premiere orthopedic clinic located in Arizona.

Active systems:  With active systems, the surgeon creates the surgical plan, but they are not an active participant in the surgery.  The robotic device performs the work.

At this point, you may be asking yourself, why did Miller Orthopedic Specialists choose the Mako robotic device over all others?  The following graph is a representation of some current device capabilities:

This technology has been used for a number of years on both the east and west coasts.  However, the first surgeon to bring robotic assisted orthopedic surgery to the greater Omaha, Council Bluffs metro area is Dr. Clayton Thor.  Dr. Thor is a Board Eligible Orthopedic Surgeon with Miller Orthopedic Specialists.  Dr. Thor received his medical degree from University of Nebraska Medical Center in Omaha, Nebraska and completed his residency at William Beaumont School of Medicine, Department of Orthopedic Surgery in Royal Oak, Michigan.  He then completed a Fellowship Program focusing on Adult Reconstructive Surgery at Headley Orthopedic Institute in Phoenix, Arizona.  During his Fellowship, Dr. Thor had an opportunity to train on robotic total joint replacement under two Master Orthopedic Surgeons, who also focus on robotics.  Dr. Thor has done approximately 160 surgeries utilizing the assistance of the Mako robotic-arm, as of June 2019.

Before scheduling a robotic procedure, you may want to ask your provider the following questions:

  1. What type of technology are they using – Passive, Semi-active, or Active?
  2. How long has the device been in use?
  3. What certifications/training do they have for proper use of the device?
  4. How many surgeries have they completed with the assistance of the device?
  5. Is there clinical data available to show benefits, such as shorter recovery time? Or lower costs associated with using the device for assistance during surgery?

Are robots taking over the world?  As far as orthopedic surgery is concerned, at this point in time, robotic assistance is a highly advanced tool that allows the surgeon to create a patient specific surgical procedure, create a 3D model to ensure precision, and navigate placement to save soft tissue and balance the joint.  Over the last couple of decades, robotics related to orthopedic surgery have advanced well beyond simple navigational tools.  We are excited to see what capabilities the technology of the future will bring.

*Future Science Group, Journal of Comparative Effectiveness Research – A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty.

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