Robotic Surgery – A surgeon’s perspective
Schivo took the time to talk to Mr Joseph Butler a pioneering Irish orthopaedic surgeon who performed the country’s first robotic spine surgery.
- Brief introduction about yourself relating to spine surgery?
I am a Consultant Spine Surgeon at the National Spinal Injuries Unit at Mater Misericordiae University Hospital & Mater Private Hospital. I completed my surgical training in Trauma & Orthopaedic Surgery at the Royal College of Surgeons in Ireland (RCSI). I subsequently completed clinical fellowship training in complex spine deformity and tumour surgery at the Royal National Orthopaedic Hospital, Stanmore, UK; spine trauma and degenerative spine surgery at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA; and complex, revision and minimally invasive spine surgery at the Rothman Institute, Thomas Jefferson University, Philadelphia, USA.
I am an active clinical and laboratory researcher and was awarded a PhD in bone biology by University College Dublin. I have over 100 publications and 100 presentations at national and international scientific meetings. I am the Secretary of the Irish Spine Society and sit on the Biologics & Basic Research Committee and Robotics & Navigation Committee of the North American Spine Society (NASS), the largest spine society in the world.
- What Robot do you work with, what is the application of this Robot, how long did the training take?
The robot I use is the ExcelsiusGPS by Globus Medical. It is a multifunctional robotic navigation platform used to place implants in spinal surgery. I have fellowship training in image-navigated & robotic spine surgery and I was involved in the early testing of this robot. I also visited a number of clinical sites in the US & Europe prior to the launch of our Robotic Spine Surgery Program at the Mater Private Hospital.
- How does the Robot work?
The ExcelsiusGPS Robotic Navigation platform combines a rigid robotic arm and full navigation capabilities for precise trajectory alignment in spine surgery. The system is designed to improve accuracy and optimize patient care by using robotics and navigation. The system supports screw placement using a variety of different approaches. I use an intraoperative CT scan as part of my surgical workflow to visualize, plan, and navigate patient anatomy in real-time.
- What is the most useful instrument in the suite of instruments?
I have a newly designed navigated high speed burr which is excellent for reducing the margin for error associated with screw placement.
- Which instrument if any do you find that you use outside the intended use?
- Which tools would you use more, heated electro-cautery instruments or non-electric surgical
I use predominantly non-electric surgical instruments, such as retractors, high speed burrs, drills, taps & screws.
- Is there a type of instrument or adaptation of an instrument that’s not on the market that you think would be useful?
It would be great to have improved clear sterile drapes to cover my intra-operative screen that minimize glare, which can be a problem.
- Where do you see robotic surgery advancing to?
I think we are going to continue to see huge advances in the world of robotics in spine surgery. We currently use robotic navigation to place screws in the spine. However, I can see a time in the not so distant future when we will be placing interbody cages & doing very complex bony work with robotic assistance.
- Do you think in the near future a surgeon could be in a different location or even country than where the surgery is taking place?
No. I feel the primary surgeon will always need to present in case there is a technical failure or unexpected intraoperative complication that needs to be addressed.
- How much quicker is recovery from robotic surgery using ports over regular open surgery?
Robotic assisted surgery allows us to use smaller incisions and perform surgery using more minimally invasive techniques. These techniques minimize blood loss and muscle damage and result in patients being discharged home quicker and having a faster recovery.
The Robotic surgical market is increasingly looking to reduce the footprint of robotic systems to enable easier transportation within hospitals. Companies are also creating micro surgical systems to facilitate better precision for surgeons. An example of this is CMR who make the Versius surgical system for the laparoscopic market which has just received CE and FDA approval. Other companies that are participating in the market include Medtronic, Verb Surgical, TransEnterix and Titan medical.
Schivo is an experienced partner bringing robotic surgical devices from design concept through to full product build and ramp for manufacture. We support customers robotic needs including micro-machining components, precision machining complex geometries, electro-mechanical device assembly and full product build and test under one roof. We understand that intricate builds can lead to a large global supply chain, we work with our customers and manage this on their behalf consolidating the chain saving time and money. Our facilities are ISO 13485 certified and we ensure manufacturing processes are operating within 6 sigma limits.
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