As spine robots and enabling technologies become more popular, the question arises on how to train new surgeons.
Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, pointed to one point of conflict in contemporary surgical training.
He spoke with Becker's about how Rothman approaches robotic training, along with his outlook for biologics in the specialty.
Note: This conversation was lightly edited for clarity.
Question: How is Rothman thinking about robotics training, specifically for newer generations?
Dr. Alex Vaccaro: Here's the dilemma facing modern surgical training. Everything's based on anatomy. Anatomy determines function. If you don't have a strong understanding of anatomy, you're like a pilot that only knows how to fly a plane using advanced electronics. If the electronics fail then you will be at a loss on how to safely land the plane. That plane may eventually crash. We always have to train our students on the three dimensional anatomy of the spine regardless of the methodology, ie. text books, articles, cadaver, simulated models etc. Only once anatomy is mastered and basic surgical techniques are learned should we migrate into advanced imaging navigational technologies such as robotics.
I use robotics every week, and it tremendously decreases the mental stress of surgical fixation especially in complex deformity cases while reducing radiation exposure assuming all safeguards are followed. For instance in pelvic fixation you no longer require fluoroscopic guidance and exposure of relevant surgical landmarks to safely place screw anchors. The surgical exposure is much less and screw size can be maximized. But remember, things don't always work out as planned and you need to be able to abandon this technology if necessary and rely on your surgical skills and knowledge to safely complete a case if the technology fails or is not available. It is our responsibility as teachers to train surgeons to understand how to operate using traditional methods such as anatomic landmarks and radiographic imaging.
Q: In terms of biologics, what interesting research have you been doing in that realm?
AV: Biologics is an interesting field. We have available in our armamentarium substances that are osteogenic, osteoinductive and osteoconductive. With so many products and local bone sources to choose from it is imperative that we follow the evidence on what products are cost effective compared to local bone graft. At the present time the most clinically effective osteoinductive product on the market is bone morphogenic protein. Research today is focused on other inductive agents as well as substances that mimic bone cell adhesion molecules, osteoconductive scaffolding and agents that are osteopromotive. In light of the many products available the surgeon has to make a choice based on evidence and cost.