The Era of Robotic Surgery

In the world of surgery, Laparoscopy / Arthroscopy have changed for ever the face of Medicine during the last twenty five years. A physician who is unable to learn the new skills, has lost his impact in delivering medical care. Around 800 000 Total Knee Replacements are performed each year in the USA and it is believed that by the year 2030 at least 3 millions of such procedure will be done yearly.

We started to use multiple smaller incisions to accomplish the task, rendering a more satisfied patient willing to accept esthetic scars. These procedures became safer with fewer complications and shorter hospital stay. Often, patients will insist in having such mode of treatment allowing them to benefit from a speedy recovery or a faster return to work.

More recently, Robotic surgery has evolved as the state of art in many fields like Cardio-thoracic and Orthopedic surgery becoming an alternative to the minimally invasive surgery. Simply, imagine a three dimensional visualization added to the conventional laparoscopic or arthroscopic  instrumentation, allowing a surgeon seated at a remote location to maneuver instruments while performing in difficult cases with precision.

Indeed, Robotic Surgery has gained acceptance first, in urologic procedures like Prostatectomy and while perfecting the surgical techniques, we are now using it in other surgical fields like in Oncological procedures for Bowel or Kidney resection.

Many orthopedic centers in the United States are presently¬† advertising for “robotic full total knee replacement” using a robotic arm. This procedure, only offered less than a year ago in the United States, has shown promising results especially in patients who have benefited from the Conventional technique in Total Knee Replacement on one side and from the Robotic arm assisted technology for Total Knee Replacement on the other side, in preliminary studies. The side performed through the assisted robot arm recovered faster in regaining its range of motion and strength.

Robotic assisted surgical procedures also highlights the difficulty in evaluating and testing such surgical interventions. We believe that, this new way in performing knee replacement will be beneficial but more time is needed to justify the added costs. Any candidate able to receive this kind of total knee replacement will need to undergo a CT scan study of the knee to generate a 3 D  computer model delineating the bone for proper planning and sizing during the pre-operative period. Then the surgeon will use such templates to perform the precise intra-operative cuts assuring this way, an accurate balance of the soft tissues. A more stable total knee replacement will result.

Many robotic assisted procedures have received a widespread acceptance despite a lack of data to support them. Prostatectomy, colon or kidney resection are performed routinely in using such technique. It is now time to turn to Robotic assisted Total Knee replacement for testing and through improved outcomes in clinical trials, we will be able to justify any additional cost necessary for a successful procedure.

Time only will allow us to judge if the expenses were necessary. In reality, we are living longer and staying healthier but we remain convinced that one will certainly refuse to accept limitations in a world which allow us to be so active.

Maxime Coles MD

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