The health care industry is known for its innovative uses of new technology, and in a variety of different areas, robotic surgery is becoming increasingly popular. This type of surgery allows surgeons to be more precise, have more control and offer surgeries that are less invasive. Through minimally invasive robotic surgery, patients can usually expect less pain and blood loss, quicker recovery and smaller scars.
Better yet, robotic procedures cost roughly the same, and because of the decreased amount of required recovery time in hospitals, they actually can result in lower out-of-pocket costs for patients.
Data shows that use of robotic surgery nationally has increased drastically, from 2 percent of all general surgeries in 2012 to 15 percent in 2018, according to the American Medical Association.
Arkansas hospitals are putting this robotic surgery into practice in different ways.
Dr. J. Tod Ghormley, an orthopedic surgeon with Conway Regional Health System, has been using the Mako robotic arm-assisted technology to perform hip and knee surgeries at Conway Regional Medical Center since September 2018.
For those undergoing joint replacement, Mako offers the potential for more precise customized positioning of implants. First, a CT scan of the area is uploaded into the Mako software, creating a 3D model the surgeons can use to help preplan the surgery. The plan is carried out in the operating room, where surgeons can make needed adjustments by controlling the robotic arm that helps execute the procedure with greater precision and accuracy.
For patients, Ghormley said undergoing a Mako-assisted surgery means a likelihood of improved range of motion, less time on crutches or using a walker and an ultimately shorter recovery time — which for some patients, can be a little too exciting.
“With total knees, instead of being on the walker for six weeks, I have them on the walker for four weeks,” he said. “A lot of them come in the clinic two weeks after the operation, and I have to say ‘Where’s your walker?’ I kind of chastise them to get back on their walker, or at least a cane… But these patients, you have to slow them down. If [they] don’t have pain and the hip or knee feels really balanced and stable and solid, then they just do what they want to do.”
Ghormley said that integrating new technology is exciting and common but warns against simply “jumping on the bandwagon.” It’s important to make sure patients’ best interests are being considered, he stressed. And through firsthand experience, he knew Mako-assisted surgery represented the best option for Conway Regional patients.
After three decades of replacing hips and knees and a few months into using the Mako on his patients, Ghormley ended up on the table having his own hip replaced. He found a colleague in Shreveport, La., to perform his hip replacement.
“The guy who did my hip surgery was one of the guys who pioneered and helped start the Mako robot for hips and knees,” Ghormley said.
Post-operation, he was back in his office seeing patients and taking the stairs after one week.
Years earlier, his wife had traditional hip replacement surgery in Little Rock. Ghormley said he and his wife chose who they thought was the best surgeon in the state for the surgery. It took three weeks on each hip for his wife to be able to walk upstairs.
“If I looked at her X-rays, every surgeon tries to do the best job he can, but I think the placement of her prosthesis was not as ideal or precise as the ones we do,” Ghormley said. “In contrast, when I had my hip done, the robot is extremely accurate. It’s within less than a millimeter of accuracy. It’s amazingly accurate and precise.”
Accuracy and precision are key terms when talking about robotic technologies. This is also the case with Excelsius, the assisted spine robot at the University of Arkansas for Medical Sciences (UAMS).
Dr. Noojan Kazemi, a UAMS neurosurgeon who specializes in surgical treatment for complex spine disorders, said Excelsius helps surgeons plan where to accurately place spinal instrumentation.
“It allows us to do the operations we’ve always done very safely but more minimally invasive,” he said. “What the robot has allowed me to do is perform surgery really through keyholes through a minimally invasive [procedure]. I did a gentleman above the age of 80 with the robot, and he was able to be discharged from the hospital very shortly after the surgery.”
As with the Mako, patients’ CT scans are acquired preoperatively. Kazemi said that the scan is later matched up to two or three X-rays taken during the operation, and as a result, he can pinpoint exact areas anywhere in the anatomy of the spine. The benefits of using the Excelsius are less tissue disruption, less muscle pain and less blood loss during surgery.
The faster recovery times and shorter hospital stays are critical in the time of COVID-19, he noted. In fact, the virus itself and the threats it poses have led to even more robotic technologies used outside of the operating room, such as the LightStrike germ-zapping robot, the first and only disinfection technology proven to kill (in two minutes) bacteria and viruses related to the virus.
Arkansas Heart Hospital was the first health care facility in Little Rock to utilize this advanced technology. The portable robot runs in five-minute cycles and can disinfect most patient rooms in 10 to 15 minutes. Following cleaning by staff, it is brought into rooms to ensure a deep clean and infection prevention.
The use of robotic technology, both inside and outside of surgery, is becoming more accurate, prevalent and available in the health care industry, and Arkansas hospitals intend to be on the forefront of new technology.
“We are always looking at the most cutting-edge technology that is available in the world, and I can honestly tell you that we probably have the most up-to-date technology anywhere in the world,” Kazemi said.
Equipping residents in the use of robotics has become more mainstream. Dr. W. Conan Mustain, assistant professor of surgery in the Division of Colorectal Surgery in the UAMS College of Medicine, recently wrote about the use of robotics technology in residency programs:
“Surgeons are really discovering that the added stability and ability to suture realistically are advantageous. Medical students and residents are on top of this. A recent study showed that 80 percent of graduating medical students going into surgery said that training in robotics was important for where they choose to go for residency.”
Ultimately, as with any other medical procedure, the use of robotics comes down to whether or not it betters the life of patients, Kazemi said.
“It’s a great thing to have a new tool, but… will it have the same outcome? Will it be done more minimally invasively? And is it more efficient and less costly? When those things line up, when those points line up, then we know it’s a good decision.”