100 ROBOTIC SPINE SURGERY CASES

I’ve been using Mazor Robotics to help me with minimally invasive spine surgeries for a little more than three years now. I was trained on the technology back in 2014 and, since then, have performed over 100 surgeries using their robotic guidance systems. I’ve assembled a few of my thoughts on what the technology can do, where it’s going and the impacts it can have for patients around the world.

THE LEARNING CURVE FOR MINIMALLY INVASIVE PROCEDURES IS NOT AS STEEP AS ONCE BELIEVED

One of the most highly-touted reasons why robotic spine surgery has not been adapted and implemented in healthcare systems more broadly across the United States is the fear of the “learning curve” that is so often associated with the technology.

A study performed back in 2014 by the Minimally Invasive Spine Center of Excellence found that it typically takes surgeons “20-30 consecutive cases” to hit maximum efficiency with the technology and overcome long operative times and complication rates.

Having gone through the training process and watched other surgeons learn the technology, I believe that is a very conservative number. Personally, I felt comfortable with the technology almost immediately after getting my hands on it. Albeit, I’m typically very technology oriented when it comes to minimally invasive technology, so my experience may not be true for all surgeons across the board. However, this study was performed back in 2014, which is when I was initially trained, and I think the technology has improved dramatically since that time.

SURGEON RELUCTANCE TO ADAPT NEW TECHNOLOGY

I think the real reason robotics aren’t being widely implemented across the country is due primarily to the fact that surgeons are reluctant to learn something new and advance their skills. I’ve spoken to hundreds of neurosurgeons who have read the manuscripts lauding the technology’s accuracy, watched demonstrations at national conferences and even heard firsthand accounts from other surgeons who are consistently using the product and yet, many feel like they’re doing just fine without it, so why change?

Well let me tell you. There are many reasons why we should adapt and progress with the latest technologies in our field, but the biggest reason is for the sake of our patients. When a patient agrees to undergo spine surgery they are, quite literally, putting their lives and well-being into the hands of their surgeon. This is no easy task, yet they do it because they trust that we will do everything in our power and use all the technology that we have available to ensure a favorable outcome for them. However, if we’re not adapting and growing with technology that is emerging in our field, then we are not providing patients with the best care that they can receive. Now, I’m not saying that neurosurgeons need to chase every new technology that comes around; we only have so much time to give. However, robotic spine surgery is not a fad. It’s proving itself time and time again in the operating room and is truly providing better outcomes for people. As nuerosurgeons, if we refuse to adapt and improve simply because we think things are “good enough as they are” we are doing a disservice to our patients.

IMPROVED EFFICIENCY AND SAFETY

To me, this technology is a lot like the rearview cameras in many vehicles now. Years ago, when they first started coming out, people would ask, “Why can’t I just turn my head? That works just as well.” Now they’re standard in almost every car that’s manufactured these days and people feel vulnerable without them. It’s not that we can’t back out of our driveways without the camera, we can turn our heads just as easily, but the technology has provided us an extra layer of efficiency and safety that we didn’t have before.

It’s the same with robotics. We can perform a good surgery without the technology, but robotic guidance has allowed us to be more efficient and more safe in the operating room. Why would we deny that to our patients?

ROBOTICS ARE CHANGING SPINE SURGERY

Robotic guidance is changing the way that surgeons are able to deliver minimally invasive spine care. With this technology, we are able to access a level of precision that was simply impossible to achieve with the human hand. Even the best surgeon can’t be 100% accurate 100% of the time, but you don’t have that problem with a robot.

Research has shown that, by hand, surgeons are approximately 92% accurate while technologies that use Mazor Robotic Guidance are around 99% accurate. Now, 8% may not seem like a big difference on paper, but it’s actually vitally important. One screw that is misplaced in the spine, even by a couple of millimeters, can mean more pain for a patient and even repeat surgeries. For years, we’ve settled for placements that fall in the general neighborhood of where they should be. But from a patient's standpoint, this is absolutely unacceptable. Mazor robotics has raised the standard for what accuracy needs to look like in spine surgery and neurosurgeons need to adapt.

Another incredibly exciting benefit of robotic guidance is the added layer of safety it provides to the patient and the operating room staff during surgery. The way we employ Mazor facilitates a minimally invasive approach, which is exactly what we want. Using robotic guidance reduces the need for intraoperative x-rays and also reduces radiation exposure for patients and OR staff. We don’t need to expose large areas of the back and cut through muscles in order to access the spine anymore. Rather, through the power of robotic guidance and a 3D synchronization of the patient's spine, I am able to see everything that I need to from the screen, meaning that I only have to work through a small opening. This helps surgeries go faster and more efficiently, not to mention they are significantly less invasive and allow me to spare everyone in the operating room from unnecessary radiation.

ROBOTIC SPINE SURGERY WILL SOON BE THE STANDARD OF CARE

I believe within the next decade, robotic guidance will become commonplace in hospitals throughout the United States and around the world. The technology is only growing more and more efficient and advanced, costs are decreasing which means that more hospitals will be able to afford it and younger generations of neurosurgeons are already being trained on how to use it which means there won’t be a learning curve to overcome once they’re in the field.

I’ve spent a lot of time around robotic guidance systems and I’ve seen how powerful its benefits can be when used correctly by a trained professional. Throughout my career I’ve watched this technology push the boundaries of what we, as surgeons, believed was possible and deliver extraordinary results to patients. I’m proud to have used Mazor for over 100 cases and I’m looking forward to using it for many more.