Robots in the operating room

Essentia

When Dr. Roxanne Keene joined Essentia Health in 2019, she had just started hearing of a new robotics system to assist surgeons with knee-replacement procedures. She considered what the new tool could do for surgeons and patients alike, and thought someday maybe she would get to use it.

Those thoughts came to fruition this past July when Essentia Health adopted the ROSA Knee System. As expected, it has helped Keene, an orthopedic surgeon specializing in knee-replacement, while in the operating room. It also has been a boon for many patients.

By Andrew Weeks

“The technology behind it – and the reason Dr. (Sam) Lindemeier and I chose the ROSA – is because it allows us to still do what we were doing before; it doesn’t change our technique a lot. What it does is it gives intraoperative feedback, and so by making a more precise position for the implant, it gives better quality outcomes.”

Those better outcomes are what matter when it comes to surgery and patient recovery.

The ROSA, designed by Zimmer Biomet, uses data collected before and during surgery to inform surgeons about details related to the patient’s unique anatomy that may affect the implant fit. The ROSA, which has its own arm-like appendage and a computer monitor, doesn’t perform the surgery, but instead works as an assistant, providing real-time data that allows the surgeon to plan for and carry out personalized surgery based on the patient’s individual needs.

Trackers or navigational tools are placed in the femur and tibia. The robot arm moves with the placed tracker, always keeping aligned with it; the computer reads information and relays it to the surgeon.

Dr. Keene said knee arthroplasty is a “very successful surgery in and of itself.” She used to send patients for an MRI before surgery to help with preoperative planning, but with the new system that step has been eliminated.

“Before surgery, I knew exactly what prosthesis was best for the patient,” she said. “With the ROSA, I don’t need to get that preoperative MRI. It’s just a preoperative X-ray, so it shortens the time for the patient, and then we do the preoperative plan. We kind of have what we had before; but now by balancing the knee and looking at more of the soft tissue, we can make adjustments in surgery as well. … Those little, subtle differences hopefully improve outcomes.”

The majority of patients who need knee-replacement would be candidates for the ROSA system, Keene said, but it is especially recommended for patients diagnosed with osteoarthritis who have knee pain, swelling, stiffness and decreased flexibility despite undergoing conservative treatment.

The ROSA is an example of the direction the medical field is heading in an age of robotics and artificial intelligence. The global pandemic has certainly accelerated the technology’s use and development, prompting an even more vigorous look at the ways it may benefit the health care industry and its patients.

“As technology continues to intensify, robots are used to assist surgeons in performing delicate and complex procedures and to deliver care to patients in hospitals and long-term care facilities,” according to a Forbes report on May 31, further noting that technology, including AI, may help analyze “large amounts of data and identifying patterns that might help researchers and doctors better understand conditions like cancer, as well as liver, kidney and heart disease.”

Business Insider reported in 2019, a year before the pandemic, that a market intelligence report by BIS Research noted the global health care robotics market was valued at $5.40 billion in 2017 and is estimated to reach $11.44 billion by 2025.

The ROSA is an example of what the future of health care may look like in the region and around the country.

Keene and some of her colleagues unveiled the system during a seminar on Sept. 27 in Fargo, sharing with those in attendance this option for knee-replacement surgery.

She said it is not the only robotics orthopedic system on the market – “there are different implant companies and obviously they are all tried and true,” she said – but the ROSA allows Keene to stay with the procedures with which she is already familiar.

“I didn’t have to learn the nuances of a new system,” she said. “But again, this just gives us a little extra advantage.”

Keene also said patients she has met with for their six-week post-surgery visits have been “very happy” with the outcome.

“Like I said, it doesn’t change the procedure a lot for us,” she said, noting since the system is still fairly new there are no prosthetics longevity studies available just yet. “But our hope is that there’ll be more longevity of the implant; if it gets in the more optimal position, hopefully long-term we’ll see better results.”