Redd Warburton, a senior executive search consultant, specialising in orthopaedics and spine, argues that while there are significant hurdles to overcome for robotics to be adopted within routine spinal surgery, robotics is here to stay.
Robotics undoubtedly has a place within spinal surgery, so why has market penetration been so limited? While robotics has achieved some encouraging results compared to traditional operating techniques, it has yet to completely prove its significant advantages over other, much less costly, navigation solutions. Factors such as affordability and the degree of value added by such technology are just a few of the significant barriers to the use of robotics within standard practise spinal surgery.
Robotics within surgery is still very much in its infancy, with as little as just 10 years’ worth of data to prove its clinical worth on accuracy and long-term patient outcomes and with the costs/time associated with robotics, it is no surprise that the adoption process has been slow. It is suggested that there is a resistance as some surgeons “feel disempowered by robotics” (Keith Jackson, former CEO, JRI). The challenge with the adoption process amongst surgeons therefore is proving its worth as bringing an expensive and intricate device into surgery where surgeons feel they can perform sufficiently without.
Reducing surgeons’ skills set
Relying on robotic assistance within spinal surgery runs the risk of de-skilling surgeons over time as the ‘difficult’ element of their job is significantly reduced; particularly if robotics replaces not only routine procedures, but the more technical cases.
Furthermore, it has been suggested that robotic assistance unnecessarily alters how relatively commonplace surgeries are now performed. This runs the risk of adding additional cost burns whilst jeopardising surgeons’ enjoyment of dealing with these cases themselves. For robotics to be truly revolutionary, it should change what surgeons are currently doing, not just enhance routine surgeries.
Efficiency
A study conducted by the Society of Minimally Invasive Spine Surgery found that surgical outcomes for robotic-assisted spine surgery showed significantly less complication than the outcomes of surgery performed free-hand. Complication rates varied from just 4% (robotic-assisted) to 12.8% (free-hand) when taking all other external factors out of consideration such as surgeon, patient age, gender, BMI and length of surgery. The reduction in the risk of postoperative surgical complications could in turn result in significantly shorter recovery times for patients.
Further to this, robot-assisted pedicle screw placement has been found to have a substantially higher level of accuracy than those placed by hand, hence an existing preferential treatment towards pedicle screw placement in this way, leading some to ask whether more spinal surgeries should be utilising robotics.
However, issues arise when the process of preparing a robotic surgery case is scrutinised. It has been suggested that the time required to invest in preparing a robotics case could be unjustified unless talking about a complex deformity case (Scott Way, COO, Statera Spine). The increasing time constraints upon surgeons means that in many cases “surgeons just do not have an extra 15 minutes to spend on each patient” in order to programme the robot to for the particular case in hand (Ben Pitcher, CCO and Joe Walland, CEO from Medicrea).
The key missing ingredient for robotics to work in degenerative cases is good data on the patient’s anatomy without significant work. There are companies within the field that are now offering pre- and postoperative support with regards to software in order to remove any significant extra work for the surgeons—a pioneering solution which could drastically change the rate of adoption for robotic assistance within spinal surgery.
Cost
In addition, there are the huge cost implications of introducing robotics into routine spinal surgery into health systems already constantly battling against financial restraints. The cost is not just the initial purchase, but also the significant burden of maintenance and ongoing programming.
Historically, healthcare providers are less efficient at measuring fewer tangible costs like; initial preparation and economic contribution into society through patients being discharged from hospital and returning to work much quicker (Keith Jackson—former CEO of JRI).
Conclusion
From planning to postoperative care, it is likely that over time robotic assistance in spinal surgery will become increasingly common due to the huge potential that robot assisted surgery holds for the industry when carried out effectively.
Present studies suggest that the biggest barriers to market are the time required to invest in preparing a robotics case and the significant cost of investing in robotic technology. However, this has to be weighed against the benefits to both patients—in terms of accuracy of the surgery itself and the subsequent recovery time, and to the surgeons themselves in alleviating the burdens already placed upon them.
There remains a long road to mainstream adoption of robotics within spinal surgery. For this to happen robotic manufacturers will need to clearly prove how such robotic assistance can improve clinical outcomes, increase the efficiency of surgical procedures and do all of this within a constrained financial budget.
Companies have been developing innovative robots to be used in surgery since the early 2000s and several of them are accepted by surgeons, indicating the tremendous potential of surgical robots. Worldwide, the surgical robots market is projected to surpass US$24 billion in annual revenues by 2025, and adoption will pick up momentum as more and more market leaders bring innovative solutions to the forefront.
While there are significant hurdles that the industry will need to overcome in order for the robotic assisted spinal surgery industry to reach its full potential, robotics is here to stay. The adoption process is likely to be slow and there will be setbacks along the way—but with clinically-supported trials and ever-increasing manufacturing advances, the market has the potential to be revolutionary.
References
- Dyrda L. Robotics in spine surgery—15 things to know. [online] Available at: https://www.beckersspine.com/spine/item/45194-robotics-in-spine-surgery-15-things-to-know.html [Accessed 28 May 2019].
- Dyrda L. Robotic-guided MIS spine surgery: Are outcomes different than fluoroscopy and freehand? Five key notes. [online] Available at: https://www.beckersspine.com/mis/item/34863-robotic-guided-mis-spine-surgery-are-outcomes-different-than-fluoroscopy-freehand-5-key-notes.html?tmpl=component&print=1 [Accessed 2 Jun. 2019].
- Gramignano E. The evolution of orthopaedics—and how greater insight is needed as funding pressures increase. [online] Available at: https://www.med-technews.com/features/the-evolution-of-orthopaedics-and-how-greater-insight-is-nee/ [Accessed 2 Jun. 2019].
- Implants-event.com. Will robotics revolutionise orthopaedic surgery?—Implants 2018. [online] Available at: https://implants-event.com/technology/will-robotics-revolutionize-orthopaedic-surgery/ [Accessed 1 Jun. 2019].
- Liu CJ. Robotics in spine surgery: Is it a Tesla or just another plug-in hybrid car? [online] Available at: https://www.healio.com/spine-surgery/minimally-invasive-surgery/news/print/spine-surgery-today/%7Bb7508361-d019-4b00-9dcb-1f7c7895f359%7D/robotics-in-spine-surgery-is-it-a-tesla-or-just-another-plug-in-hybrid-car [Accessed 28 May 2019].
- Schneider L. Spine surgery “hype”? Robotics, biologics, navigation, lasers. [online] Available at: https://www.spineuniverse.com/professional/news/spine-surgery-hype-robotics-biologics-navigation-lasers [Accessed 5 Jun. 2019].
Redd Warburton is senior executive search consultant at CSG Talent, specialising in orthopaedics and spine.
