Issue link: https://beckershealthcare.uberflip.com/i/1467576
57 ORTHOPEDICS AR vs. robots: What spine surgeons prefer today By Alan Condon W hile still in their infancy, robot- ics and augmented reality have demonstrated significant poten- tial in spine surgery, with many surgeons excited to see how these two technologies will be integrated in the future. But which technology are surgeons gravitating toward as they stand now? Question: If you had the opportunity to implement ei- ther an AR spine system or a robot at your practice tomor- row, which technology would you choose and why? Editor's note: Responses were lightly edited for style and clarity. Frank Phillips, MD. Midwest Orthopae- dics at Rush (Chicago): I have used AR for the past two years and it has been a breath of fresh air. is eliminates the cumbersome and time-consuming set up of robots at a fraction of the price. In addition, the use of AR in percutaneous spinal procedures pro- vides surgeons with a 3D view of the spinal anatomy and allows visual and tactile feed- back, which are sacrificed by current robots. I'm looking forward to seeing AR technolo- gies combined with robotics to optimize outcomes. Philip Louie, MD. Virginia Mason Fran- ciscan Health (Seattle): is is a tough question: I'd like them both! Both are criti- cal components and emerging technologies with early evidence-based benefits to intra- operative care. Similarly, both can be instru- mental pieces that are incorporated into a more comprehensive integrated platform (hopefully in the near future). But if I had to choose one tomorrow, I would likely select the robot. Although AR spine systems pro- vide incredible benefits with newer baseline technology, here's why I would choose a ro- bot: 1. From an ergonomic standpoint, I think we are moving toward maintaining the neck in a neutral position while operating, espe- cially in a minimally invasive surgery set- ting. AR in its current form requires looking down with a headset that adds additional weight to the neck. 2. e evidence is more robust for robotics at this point in time. I recognize that this is an evolving target. 3. Currently, robotic systems are far more in- tegrated with the ability to perform pre-op/ intraoperative planning and evaluate post- operative outcomes; ultimately assessing the intraoperative execution of our plans. Kris Radcliff, MD. Rothman Orthopaedic Institute (Philadelphia): Robotic technol- ogy has tremendous potential to enhance overall spine surgery patient safety and out- comes. e next generation of robots will lead to safer, more reproducible neural iden- tification and decompression by incorporat- ing safe zones, haptic feedback and machine vision. Robots have the potential to contrib- ute to every spine surgery. Robots can also detect physical condition changes such as a loss of resistance or change in sound that are imperceptible to humans. Ultimately, ro- botic technology will enhance spine surgery in the same manner that machine vision and sensors contribute to self-driving vehicles. Kornelis Poelstra, MD, PhD. e Robotic Spine Institute of Las Vegas: It all depends on your individual requirements for en- abling tech, and the type of surgical prac- tice you have. We see over and over that many users agree the planning component of current robotic systems is the true game changer. It is potentially less the robotic technology at this point, but more the holis- tic view and planning ability of the systems that show time and time again reduction in radiation, length of stay and overall compli- cation rates. e future for AR is very bright, and systems will soon incorporate similar planning so- ware that will allow surgeons to expeditious- ly complete surgical intervention with AR headsets following a largely automated plan for perfect screw trajectory placement, disc space preparation for fusion and interbody cage placement. is could all be offered at a lower cost than when a robotic arm of any kind is added. Competition will fuel improvements for both technologies, and combining them will truly change the game of spine surgery. We have shown this already in spring 2021 when I combinedMazor X and xvision from Augmedics in the same case and I cannot tell you how incredibly efficiently and accurately this combination helped me with speed and agility in the operating room. ere will tru- ly be a symbiotic relationship between these two technologies soon. I cannot wait! Peter Derman, MD. Texas Back Institute (Plano): An ideal system would actually incorporate both. e robot would provide stabilization and guidance, while the AR would allow the surgeon to "see" the spine without having to look up at a navigation screen, depend on fluoroscopy or perform open surgery. We are just scratching at the surface of what these technologies will enable us to do. Im- plant placement is only the beginning. In the future, I anticipate that MRI data will be incorporated as well so that AR and robot- ics will be able to facilitate decompressions. ese tools will become a platform for en- abling all spine surgeries. I'm particularly excited about the integration of AR and ro- botics with endoscopic spine surgery. Isador Lieberman, MD. Texas Back Insti- tute (Plano): Robotic technology is current- ly more versatile than the first-generation AR technology. Within the next five years all the proprietary spine surgery platforms will include AR modules, navigation modules and robotic guidance components. is will provide the surgeon with a comprehensive toolbox. Lali Sekhon, MD, PhD. Nevada Neuro- surgery (Reno): I'm not sure AR is much ahead of robots, which are fancy guidance arms. AR puts the LCD screen in our glass- es. at's about it. Both rely on navigation to power them and it's navigation I really want. Given the COVID-19 pandemic/loss of staffing, my wishlist is a little more holistic: 1. Regular operating room crew 2. Enough staff in the OR so we can do long lines and add on cases 3. Enough staff in our offices so we can func- tion effectively 4. Enough nursing staff so patients don't sit in recovery all night or cases get cancelled e pandemic has thrown hospital and office staffing into arrears and the practicalities are that our basics are being undermined. Not enough office staff, not enough nurses, low- ered reimbursement, insurance companies still fighting us. ese are my needs. AR/ro- bots are wants. Navigation is the jewel. Navi- gation means I have a wonderful iPhone, but perhaps not the latest one. Give me enough staff, operating room time and hospital beds instead of AR and robotics. n