Robotic technology is becoming more common in medicine and Mazor Robotics has introduced the technology to spine surgery in the United States. "I use Mazor's robot and essentially it is a tool that assists with the instrumentation of the spine," says Richard Francis, MD, founder of Spine Associates in Houston. "What this means is whenever we have to instrument the spine with special screws and rods, we have to first guide the screws and rods into the spine safely around the nerve. In the past, we did several X-rays in different planes to navigate screws into the right position. Mazor robotics eliminates that and the robot will find the right pathway for the screws."
The technology can be used for open, minimally invasive and percutaneous procedures. Here, Dr. Francis discusses the benefits of this technology and where it's headed in the future.
Q: What are the primary benefits surgeons achieve with the robotic technology?
Dr. Richard Francis: The primary benefit is really safety. It increases procedural safety and improves surgical time. At first it takes a little longer as you become accustomed to the technology; there's a learning curve you have to endure, but then it becomes faster and surgeries that are faster have less blood loss and complications.
The robot can also be used on more complex procedures, like scoliosis, osteotomy of the spine or revision procedures. The length of these procedures is pretty long and the robot shortens that time and reduces the risk of complications.
Q: There is a lot of focus on comparative effectiveness research today when bringing new technologies into practice. Does robotic technology have good outcomes and results to justify purchasing the equipment and learning the technique?
RF: The technology is relatively new and to publish data and results you really need a body of data collected from a body of work. The larger number of patients we have makes the research stronger. A lot of published material will become available as we do more of these surgeries. In my practice, we have a 100 percent safety with robots.
As we perform the procedure on more patients and collect data from more surgeries, we will be able to analyze the data and other people around the country will decide to use it. The fact that there is not much published data at this time is only a product of the recentness of this advanced technology; there will be more published data on it in the future.
Q: Surgeons must train on this technology before incorporating it into their practice. Is this additional training a barrier to surgeons using the technology?
RF: I don't think it's an insurmountable barrier. More and more surgeons are taking the time to learn it. At my hospital, surgeons observe with me and go on to training programs and incorporate that into their own practices and hospitals. It's not difficult because it's an extension of what we have always done, but it involves computer aided technology that requires a little bit of adaptation and learning curve.
Q: What impact does this technology make on performing spinal procedures?
RF: The impact is primarily safety. You want to perform the procedure safely without neurologic complication or deficit. Anything that allows you to navigate the spinal cord safely is better. It comes to the heart of the procedure because no matter how well we do, if you don't have a safe outcome, it's all for nothing.
Q: Purchasing the equipment is a big capital investment for any institution. How feasible is it for spine surgeons to partner with hospitals willing to purchase the technology?
RF: If there is ever a barrier to entering the field of robotic spine surgery, it will be the cost of the equipment, not technical difficulty. It means surgeons have to make the case to their local hospitals about the benefits of the robot so the hospital can acquire this technology. It's a huge investment and hospitals need to manage their business in a prudent manner. Surgeons have to demonstrate the value it will bring to the hospital.
Once you are able to make a convincing case, you won't have difficulty partnering with the hospital for these procedures. It's easy to make a compelling case once people realize it makes surgery safer. The surgeon really has to be the advocate for this technology but it is not difficult to advocate.
Q: Where is the technology headed in the future?
RF: The way that robotic surgery is done now, in the sense that we describe it, the robot shows us where to place the implants. I believe in years to come, we will have the capability of the robot to place the implant itself. Whether that's something we want to do or not is another topic of discussion, but the capability is on the horizon. That's the area we are going to develop most in the near future.
I also think that even though the robot we use now is quite small, as technology improves it will become even smaller and easier to handle. There are several opportunities for progression even though it is quite good out of the box.
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