Robotic Assisted Surgery Compared with Conventional Surgery in Orthopedics

By Adam Jameel

Introduction

Orthopedics is one of the most important fields of medicinal surgery, assisting people with a multitude of injuries from the spine to the foot. This field requires extreme dedication and resilience because subtle injuries to the musculoskeletal system can be catastrophic for the patient due to the delicate nature of the nervous system. Robotics is a new development that has garnered great interest because it is stated to be much more accurate and precise in surgery than humans, which helps reduce the amount of trauma remaining from surgical procedures. Are robotic surgical equipment safer and more precise than human surgeons? In this particular study, robotic surgery by devices like the da Vinci system, ROSA, and MAKO is analyzed to comparatively view the precision, recovery times, and subsequent complications from human and robotic surgery, and looks at average pricing for robotic surgery.


Method

In this study, the data collected to be analyzed will be based on a variety of previously done research to create and compile a conclusion on the success or failure of robotic systems in accordance to solely human surgeons. Robotics as a whole is heavily reliant on the surgeon operators so issues stemming from errors by them will be excluded from this study.

Surgery done by systems like MAKO are commonly done by operators who are surgeons to ensure that the surgery is going well. The image on the right shows a partial reconstructed surgery of a knee that had been done without a flaw by the MAKO system, which implemented CT scans that can assist finding out where to put the implant. This precision had led the patient to have reduced scarring, better positioning of the implant, and less pain as the patient grew older. Precision is also aided by the robotic systems needing less operational area [3]. In comparing conventional vs robotic surgery in the field of total knee arthroplasty (TKA), robotic surgery is more capable of inserting the implant due to the accuracy and steadiness that humans cannot achieve. This is because systems like MAKO require many more prior visits and scans to calibrate the device to become more personalized with each patient. This is an issue because it does increase wait times to get into surgery and the device does not function without sufficient imaging, hindering emergency response and causing a thirty minute delay in surgery (non significant) [1].

Recovery times for a surgery are especially pertinent in Orthopedics. The MAKO device often boasts of a decreased duration for discharge to more precision, which yields a decreased rate of time until hospital discharge. This is because of the decrease in surface area in TKA surgery being exposed since the MAKO device relies on prior imaging to be done. In order for recovery times to be sufficient, MAKO devices in TKA employ a strict amount of area necessary to be worked on, and anything outside that area is mitigated. This does tie in with reduced rates for complications because it leads to less damages that could arise from mismanagement. Because less area is handled, there is decreased intraoperative complication rates (OR: 0.12, 95% Cl: 0.05 to 0.034, p<0.0001 l2) [1]. In the image below, RA, which is robotic assisted, has no events that are complications, while CA (conventional) ends up with many more errors in accordance across a variety of studies in total hip arthroplasty.


Pricing for surgeries is imperative to consider because patients may not proceed with surgery if it is too expensive. Robotic surgery has cost much more than conventional surgery due to the various intricacies that arise. The cost of MAKO by itself is around one million dollars just to install because it uses the Stryker technology [4]. The heavy expenses force private practice surgeons and clinical hospitals to look elsewhere. Robot knee replacements and surgeries do tend to cost more for the patients as well. The average cost is 26% more than usual and patients who undergo TKA report them costing $12,000 compared with the conventional $10,000 [2] . This does not include any potential for complications and prior imaging costs. While more imaging is required which makes MAKO cost more, it reduces the need for repeat visits since less damage and complication occur. However, the value, which is estimated by quality of life and less complication, is not comparable since robot assisted surgeries excel in that sector versus conventional [5].


Conclusion

MAKO and other robotic assisted devices do boast of precision, decreased complication rates, higher quality of life, and quicker recoveries. However, they end up costing more, taking more operative time, and requiring more imaging. This study concludes with the comparison between robotic assisted surgery in orthopedics and conventional surgery and poses the issue of requiring further research. While data and research point towards the fact that robotic assisted surgery is superior to conventional, more research is needed to cumulatively declare it significant enough. Further studies are needed to explore the long term benefits from robotic surgery.


Educational Content

1. What are the benefits of robotic surgery?

Robotic surgery can lead to quicker recovery times and more precision. This signifies the commonalities seen by various studies and surgeries since robotic surgery can reduce the damages incurred over time, leaving everyone safer and more at ease due to less injuries.


2. Is robotic assisted surgery like MAKO absolute?

The surgeries that are done are classified by the FDA as safe, which dictates that in the status quo, MAKO is a perfectly safe and present way for surgical procedures. But research has not been finished on the issues that may stem long term, since MAKO has not been around for long, leaving later risk for patients.


Citations:

Chen, Xi, et al. “Robotic-Assisted Compared with Conventional Total Hip Arthroplasty: Systematic Review and Meta-Analysis.” Postgraduate Medical Journal, The Fellowship of Postgraduate Medicine, 1 June 2018, pmj.bmj.com/content/94/1112/335.1.

Dotinga, Randy. “Robotic Knee Surgery: Fewer Problems, More Expensive.” Medical News and Free CME Online, MedpageToday, 16 Mar. 2019, www.medpagetoday.com/meetingcoverage/aaos/78613.

Ren, Yi, et al. “Efficacy and Reliability of Active Robotic-Assisted Total Knee Arthroplasty Compared with Conventional Total Knee Arthroplasty: a Systematic Review and Meta-Analysis.” Postgraduate Medical Journal, The Fellowship of Postgraduate Medicine, 1 Mar. 2019, pmj.bmj.com/content/95/1121/125.

“Robot Wars: Knee Surgery Marks New Battleground for Companies.” CNBC, CNBC, 6 July 2017, www.cnbc.com/2017/07/06/robot-wars-knee-surgery-marks-new-battleground-for-companies.html#:~:text=MAKO, which uses only Stryker's,less than half the price.

Waddell, Bradford S, et al. “Technology in Arthroplasty: Are We Improving Value?” Current Reviews in Musculoskeletal Medicine, Springer US, Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5577416/.


Hand Robot Machine Artificial - Free image on Pixabay

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