Are Robotics the Future of Surgery?

In this age of rapid technological advancement, every industry is undergoing nearly constant change. Health-care is no exception. Many technological advancements are welcomed with open arms. Personally, I loved that I could help stroke patients learn to walk more effectively through use of partial body weight offloading harnesses during a clinical rotation this fall. Scientists are currently sequencing genomes thanks to technology. There is a treasure trove of knowledge that is waiting to be unlocked because of the mapping of the human genome. We have better monitors for vital signs. We have wireless communication, and the ability to be diagnosed by a “doc in the box,” or web cam physician, from almost anywhere in the world. Many technological advances are welcome. Others, like the electronic medical record, are ultimately helpful, but not so welcome for most health care professionals when they are first adjusting to the change.

What about robotic-assisted surgery?

It is a captivating idea, and has tons of potential. Compared to traditional surgery, however, it has only demonstrated superiority in some areas.

This past Monday, I got the unique and awesome (if somewhat nauseating) experience of watching a total knee replacement. What a brutal surgery. I have been treating patients who have undergone knee replacement surgeries in physical therapy for a while now, but I had never seen for myself what the surgery was like before this Monday. If you are curious, look up a video online. I can not recommend it to the squeamish, but it is truly a fascinating experience.

The surgery was brutal, but efficient. The surgeon’s skill was evident because it took approximately 35 minutes to complete and he moved incredibly quickly. During a knee replacement, the patient has on a tourniquet to reduce bleeding. “Tourniquet time” is one of the biggest predictors of a patient’s results. A longer tourniquet time is correlated with a longer recovery, more chance of infection, increased likelihood of nerve injury, and deep vein thrombosis (life threatening clot). Medical literature recommends a tourniquet time of less than 100 minutes, but less is better.

  • Olivecrona, C., Lapidus, L., Benson, J., & Blomfeldt, L. (2013). Tourniquet time affects postoperative complications after knee arthroplasty. International Orthopaedics, 37(5), 827-832.

In the case of knee replacement surgeries, robotic-assisted surgeries have shown to improve bony alignment. Improved alignment can mean less chance of uneven wear on the device, or device loosening, and therefore decreased likelihood of a repeat surgery. Other advantages include a decreased change of infection. Current disadvantages include an increased operating time and higher cost.

  • Siebert, Mai, Kober, & Siebert, Mai, Kober, & Heeckt. (2002). Technique and first clinical results of robot-assisted total knee replacement. The Knee, 9(3), 173-180.

Increased operating time means increased tourniquet time. This increase in operating time is partially due to the surgeon learning curve, and partially due to the different technique between the two surgeries. In a short time, many surgeons will be experienced enough with the robotic assisted surgery to overcome the learning curve and decrease the surgery time. Hopefully, the cost difference will decrease as well. When operating times are comparable between types of surgery, the improved accuracy of the robotic-assisted surgery may mean that this is the better option for most patients.

  • Conditt, Gustke, Coon, Kreuzer, Branch, Bhowmik-Stoker, and Abassi. (2016). Surgical efficiency and learning curve during robotic assisted total knee arthroplasty. Orthopaedic Proceedings, 98-B:SUPP_7, 92-92.

As new advances comes our way, we must embrace them and adapt when new technology results in improved patient outcomes. We must also be appropriately skeptical and resist jumping into the newest technique without first evaluating and weighing the outcomes.