Orthopedic surgical robots and navigation systems still have a long way to go when it comes to accuracy, according to Richard Berger, MD, of Chicago-based Midwest Orthopaedics at Rush.
Dr. Berger spoke with Becker’s Spine Review about the direction he thinks robotics should move as well as advice for surgeons looking at new technologies.
Note: This conversation was edited for style and length.
Question: What considerations do you weigh when deciding to try new surgical technology?
Dr. Richard Berger: I invented minimally invasive hip and knee replacements about 20 years ago. I was the first person in the world to do outpatient total joint replacements about 20 years ago or so, and I’ve done tens of thousands of them.
You’re going to have to figure out a way to stay current. Unless you’re at a big academic center, don’t be the first to try something, and don’t be the last to adopt something. Be in the middle. Don’t adopt something by reading an article, or worse, hearing a lecture or by watching a video. Go and see someone. You did that for your residency and fellowship. Go and see someone do the procedure that you’re interested in.
Be honest with your patients. Don’t tell a patient you’ve done a bunch of procedures when they’re the first one. Tell your patients, “Look, there’s a new procedure. You’re the first one.” When I developed a minimally invasive surgery for the hip, we did an [Intramural Research Program] study where every patient got a number. There was a patient who I told, “You are the first patient in the entire world to ever get this procedure. I’ve been playing with it in the cadaver lab for the last four years, but I’ve never done it on a patient. Would you like to be the first?” I told the first 200 patients what number they are. I think it’s important to be honest with your patients.
Q: What technology do you think will play a major role in joint replacements in the next five years?
RB: I think eventually having a heads-up display, not necessarily a robot, but some sort of advanced navigation system will be very, very helpful. The robots and the navigation systems right now, frankly, are not very good. They’re time-consuming, expensive, inaccurate and they don’t know what they’re shooting.
For the inexperienced surgeon, it may help them. But for the majority of surgeons, it’s actually making them worse. But eventually, that technology is going to be better. It’s going to be quick, easy and inexpensive. Most importantly, it’s going to be very accurate. When that happens, I think it’s going to get adopted by everyone.
It’s kind of like before we had GPS systems in your car. If you knew where you were going, it was great. But if you didn’t know where to go when you got lost, then you either stopped and asked directions, or you got lost. That’s where robotics and navigation is now. With GPS today, everyone uses their GPS all the time, and that’s where navigation is going to be in the future, but not yet.
Q: Where are the inaccuracies you’re seeing in these systems?
RB: Accuracy is a very funny number, You can say you’re accurate but you’re not accurate. So much of the process is based upon what’s called registration, which is taking the robot or the computer system and finding out where it actually is. That’s a difficult process that you point to different structures on the bones or on the body, and that gives you a ton of inaccuracy. What the robotics companies are talking about is, “Once that’s done, can you get back to the same spot?” Well sure, that’s pretty good. But you don’t know where you’re starting from, so that’s the inaccuracy that goes into it.
The second inaccuracy is “What are you shooting for?” Let’s say you have a marksman who can hit anything and he asks, “What are we aiming at?” and you say “I don’t know.” That’s where robotics is now. We don’t know what we’re aiming at.
I can tell you what I’m aiming at with my feel of doing the surgery, and I’m really good at that. But the average robot is being programmed now by a college graduate who has no idea about orthopedic surgery replacement. That person programming the computer to do this is not an orthopedic surgeon, not someone with thousands of cases under their belt. It’s being done by the programmer who’s hired by the company to program in some random numbers that they think might make that work.