Dr. Mandelbaum Shares Thoughts with Becker’s Orthopedic Review about the Benefits of Robotics in the OR

Robotic-assisted orthopedic surgery is an issue that elicits varying responses amongst healthcare professionals and orthopedic surgeons around the country. Here, three orthopedic surgeons discuss the use of robotics and computers in surgery.

Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons around the country about clinical, business and policy issues affecting orthopedics. We invite all orthopedic surgeons and specialist responses.Next week's question: Do you utilize mobile health applications? If so, which ones and why? If not, why not?

Question: Do you feel the use of robotics and computers in the operating room is the future of orthopedic surgery? What are the benefits if you use them? And if not, why not?

Lance J. Wrobel, MD, St. Joseph Health Mission Hospital, Laguna Woods, Calif: Robotics are too expensive and [have a] huge learning curve with longer surgery times.

Dr. Gregory Tchejeyan, Los Robles Hospital, Thousand Oaks, Calf.: The use of computers in orthopedic surgery practices is now common place. Nearly all contemporary orthopedic centers use computers for medical record keeping, digital x-ray and patient data management.

With regard to robotics in surgery, Computer Assisted Orthopedic Surgery (CAOS) is prevalent. For the most part computers used in surgery are TOOLS to help the surgeon navigate position of implants, confirm implant orientation and give real time information while the surgery is being performed.

Furthermore robotics help achieve a precise and reproducible execution of implant position. In cases with altered anatomy navigation can also help orient the surgeon to the anatomical alignments. Regardless of the benefits of computers and robotics in orthopedic surgery the input into the computer or navigation of the robot is still done by the surgeon. So there is still a human role. The benefit however is to achieve reproduction of implant position from one surgery to the next with smaller tolerances, say within 1 mm and 1 degree, which we believe will improve patient outcomes.

Dr. Gowriharan Ty Thaiyananthan, neurosurgeon and founder of Brain and Spine Institute of California in Newport Beach: Computers and robotics are becoming more integrated with surgery every day. Image-guided surgery, or surgery in which a computer helps outline trajectories or helps in the visualization of anatomy, is already common place in the operating room. Robots that actually perform surgery already have established roles in urology. These technologies are now more frequently being employed in orthopedic and neurosurgical spine cases. Image guidance for example allows surgeons to more accurately placed pedicle screws in the OR.

As a consequence, these surgeries can not only be more accurate but shorter with better outcomes. There are even robots that are coupled to image guidance that help surgeons physically position the screws. In our practice BASIC Spine in Newport Beach, California, we frequently use image guidance to improve the accuracy and outcomes of our surgeries. Our patients have benefited from spinal surgery that has been more precise than ever before. Typically these have been done in a hospital setting, we are now attempting to bring image guidance to outpatient surgeries which will hopefully allow our patients to benefit from these technologies in a manner that gets them back on their feet quickly.

Bert Mandelbaum, MD, orthopedic surgeon and director of the sports medicine fellowship program and the research and education foundation at Santa Monica (Calif.) Orthopaedic and Sports Medicine Group: Computers are essential for all levels of practice in 2015. As a diversified clinical and academic orthopedic surgeon I am comprehensively dependent on computerizations and apps. These include EMR such as EPIC, injury surveillance for teams and athletes using the Healthe Athlete by Cerner, Outcome Systems such as SOS by Arthrex, Digital Imaging using the Synapse System and patient education using the Ready Set Med YouTube channel. And of course the iPad and iPhone by Apple keep the contemporary orthopedist functional at the highest level.

Yes, robots will, and now have a definite role in the planning and execution of arthroplasty procedures.