The idea of robotic-assisted surgery can conjure up some interesting images. In this article, Dr. Ballard discusses the role of robots during surgeries like joint replacement.
For most of us, our introduction to the idea of robotics started and ended with the Star Wars movie franchise. The idea of robotics conjures up images of smart, human-like machines capable of high level, critical thinking, and superhuman decision-making. In these movies, robots function independently and often outperform their human companions.
It’s no wonder, then, that when people hear that robots are making their way into the surgical arena, that they have a hard time understanding what surgical robots are, and what robots actually do in an operating room.
Does the robot perform the surgery?
Does my surgeon even need to do anything during my surgery?
Will doctors be replaced by robots?
Will this robot be a safe replacement for my doctor?
What surgeries are the robots used for?
To begin to answer these questions and better understand surgical
robotics, you must understand some key concepts. First is the idea of
passive vs. active robotics. All currently available surgical robots
are passive. This means that the robot doesn’t do anything on its own
and doesn’t perform the surgery. Think of the robot as a surgical tool
that helps to plan and execute the surgery – its role is
passive.
Active robotics, on the other hand, is what you see in automotive manufacturing where the robot acts alone and does the work autonomously with little human involvement. Think of a car moving down an assembly line with robots moving around, grabbing parts and welding things together.
In robotic-assisted surgery, the surgeon and only the surgeon thinks about, plans, and executes the operation. He or she alone uses the surgical tools for the case. The role of the robot is to assist in making that thinking, planning, and executing of the surgery as accurate and reproducible as possible.
The other area to understand is what we mean by planning, thinking, and executing a surgery. For example, in knee replacement, we replace the surface of the knee bones, like placing a cap on the bone. This involves cutting the ends of the femur bone into a specific geometric shape and the top of the tibia bone into a flat surface. The angles, shapes, and determinations of these cuts are very important and complex.
Traditionally, before robotics, we learned some very reliable techniques to create these cuts and understand these angles. However, these decisions were based on human averages, rarely tailored to a patient’s specific anatomy. We didn’t have the ability to move beyond human averages.
In addition, after creating the cuts in the bones, we could never verify how well we had performed them or how accurately we had performed the surgery. That left us, occasionally, with cuts and angles that were not ideal.
With modern robotics, we can create a virtual model of the joint specific to a patient’s anatomy and perform the surgery virtually with the robot’s computer system before we ever cut a bone. The system can then help the surgeon predict and analyze how well that surgery will fix that particular patient. If it could be less than ideal, we can go back to the virtual plan, make changes, and see in real-time the predicted improvement.
Once this process is completed, the robot comes into the surgical field to assist the surgeon in accurately cutting the bones to match the modified plan. The surgeon does the work while the robot guides the work to accurately reflect the virtual plan. Once the bones are prepared, pretend implants, called trials, are placed in the joint to mimic the final product. Advanced sensors in the robot and in the operating room allow for a sub-millimeter evaluation of accuracy and plan reproduction.
If that sounds to you like something from a Star Trek episode or a sci-fi movie I would have to agree with you. This level of evaluation, planning, and accurate pre-operation prediction have never been at our disposal before. The exciting news is that they are at our disposal now.
One of the newest generation of these robotic assistants in joint replacement is called ROSA® Robotics. Surgical robots, like ROSA Robotics, combine cutting-edge technology with our orthopedic knowledge of joint replacement and surgical planning, giving surgeons an advanced approach for performing hip and knee replacement surgery. As a surgeon, I can take a patient into the operating room and perform a hip or knee replacement with a surgical plan uniquely tailored to that patient.
It’s also important to understand that robotic joint replacement systems are each paired with their own model of hip or knee replacement implant. Think of joint replacement implant brands like a car company’s particular version of an SUV. Many car companies make and sell an SUV but they are not all the same. Some of these models are old, and some are new and updated. Some are basic, and some are loaded with technology and are very sophisticated.
Using advanced technologies like these, your surgeon is empowered to offer you a more personalized joint replacement surgery.
Important Note: This is intended to provide an overview of knee replacement surgery with robotics and should be reviewed with your doctor. It does not include all of the information needed to determine eligibility for knee replacement or for the proper use and care of artificial knee replacements. Please consult your surgeon for more information. Information may also be obtained by calling the toll-free number or visiting the website. The toll-free number can also be used to obtain complete product contraindications, warnings, precautions, and possible adverse effects. Individual results may vary. Your results will depend on your personal circumstances. How long a knee replacement will last varies from patient to patient. It depends on many factors, such as the patient’s physical condition, activity level and body weight, and the surgical technique. Replacement joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that an artificial joint will last the rest of a patient’s life. Knee replacements may need to be replaced at some point.