Robotic Surgery

Minimally invasive surgical procedures appeared associated with an elevated risk for recurrence or death vs. open surgery among women with early-stage gynecologic cancers, according to results of two studies published in JAMA Oncology.

KOLOA, Hawaii — Use of a robotic system for total knee arthroplasty requires simple and complex adaptations to workflow compared with conventional instruments, according to a presenter at Orthopedics Today Hawaii.

Patients who underwent unicompartmental knee arthroplasty undertaken with robotic assistance experienced excellent mid-term survivorship compared with patients whose surgery was performed manually, according to results presented at a meeting.

Adoption of robotic systems by orthopedic surgeons has been slow and limited due to lack of improved efficiencies, the requirement of significant capital expenditure and no convincing evidence of changes in outcomes, according to an article in The Journal of Arthroplasty, by Brian S. Parsley, MD, in 2018. However, since these were first introduced in the specialty, robotics have continued to evolve, Parsley noted, which provide greater opportunities for advanced surgical planning, optimization of component placement and improved overall mechanical alignment.

There are two areas in orthopedic surgery where robotics has been employed successfully: joint arthroplasty and pedicle screw instrumentation in spine surgery. In joint arthroplasty, robotics is used to aid the accuracy of bone cuts in total knee arthroplasty and the accurate placement of the acetabular component in total hip arthroplasty. Many cadaveric and retrospective clinical studies have demonstrated high accuracy with bone cuts in arthroplasty leading to improved overall implant alignment and increased accuracy of screw placement in pedicle instrumentation. Despite these advantages, however, it is unclear whether robotic assistance results in improved outcomes that justify its added costs. For example, the advantages gained from robotics must outweigh the added costs of the robotic system itself, the annual service and maintenance fees of the system, as well as the cost of disposables. One also has to factor in the possible increased anesthesia and operative time in the beginning of the learning curve for the surgeon, as well as the cost of preoperative advanced imaging or the use of intraoperative CT/fluoroscopy to register the patient to be tracked by the navigational system. One area where robotic surgery may improve cost-effectiveness is by decreasing the revision rates of joint arthroplasty and spine surgery. Some studies suggest a decreased need for revision surgery with robotic assistance; however, these studies, at present, are generally retrospective studies with implicit bias. Robotics in orthopedic surgery is here to stay and will help surgeons in particularly complex cases; however, more evidence is needed to determine whether outcomes truly outweigh the costs in more routine surgical procedures.

Researchers of a published study found patients with obesity who underwent robotic-assisted kidney transplantation had comparable patient and graft survival to those without obesity who underwent open transplant during the same time period. The rate of surgical complications was also low.

The concept of robotic-assisted PCI has been successfully implemented since 2011, allowing for precise navigation of catheters and stents while reducing radiation-related risks.

Siemens announced it has acquired Corindus Vascular Robotics, manufacturer of robotic-assisted PCI systems, for $1.1 billion.

SAN FRANCISCO — Robotic-assisted or fully robotic retinal surgery could improve patient outcomes by mitigating human limitations, according to a speaker here.

EFORT is proud to announce new a new fellowship, which is supported by Stryker, focused on robotics.