Becker's ASC Review

35 Executive Briefing: Robotic Knee Surgery in ASCs ASC's payer mix, but generally after the first 30 cases the costs are comparative to cases with using the robot. Navio relieves the cost barrier for acquiring new technology and allows centers to cater toward physicians who want to use the new technology. "The surgery center I work for has been physician-friendly and they usually accommodate physicians in any way they can, unlike most hospital settings," says Dr. Ting. "It was quite easy introduc- ing the Navio into the ASC, especially since I had previous experi- ence using the robotic system. The staff was in-serviced and we developed a comprehensive program." Taking the robot outpatient The center was already cutting-edge, hosting total joint replace- ments, and the robotic technology became another step in provid- ing high-level care; however, if centers are not already performing at least partial knee replacements, incorporating the robot is more onerous. "You would have to start from the beginning and get everything in place from the preoperative initiative, anesthesia and actual in- traoperative procedure for the joint replacement," says Dr. Ting. "You have to replace blood loss, monitor the patient intraopera- tively and prepare the patient postoperatively with everything from anticoagulation to physical therapy. It would be a large undertak- ing but something more centers are moving toward in the future. I think that's going to become part of the standard of care for joint replacements are done at ASCs." Robotic technology is revolutionizing surgical care; several spe- cialties now routinely use robots during procedures for accuracy and guidance. Hospitals advertise the new technology as "revolu- tionary" and patients are becoming more educated about the pos- sibility of better outcomes with the robot. In some cases, patients are even seeking out surgeons who use this technology. "In the past, this technology has been somewhat less accessible to everyone because of the cost, but now we have a system that eliminates that barrier and people are learning more about robot- ics," says Dr. Ting. "I see more patients requesting it." Trailblazing in the future There are many new technologies in orthopedics, from biologic solutions to implant design, but Dr. Ting sees robotic systems con- tinuing to develop and becoming a larger part of the surgeon's armamentarium in the future. Current numbers show around 10 percent of knee replacements performed in the Unites States are partials, but some projections show the procedure exploding by more than 650 percent over the next 25 years. "The robotic technology has allowed us to perform surgery more precisely, more accurately and have greater reproducibility; there- fore, as physicians, we will want to use it," Dr. Ting says. "Because the Navio system has been successful, I think its use will rise ex- ponentially. The demand for partial knee replacements is on the rise, and I think it will grow in the future." The move toward ambulatory surgery centers is also gaining traction among orthopedic surgeons. ASC investment allows sur- geons to remain independent while providing their patients a safe environment for surgery. ASCs typically have lower infection rates than hospitals and the personalized attention patients receive from staff make ASCs an ideal place for surgery. Advancement in pain management techniques allow patients to return home the same day of surgery and the quicker postoperative ambulation shortens recovery time. "ASCs are built just for surgery whereas hospitals treat anyone from the terminally ill to the acutely ill patients, and then also sur- gery," says Dr. Ting. "For the surgeon, the ambulatory care center is set up specifically catering to their procedure and often they work with the same staff every day. I think there is a trend to bring all sorts of procedures into the ASC, and partial knee replacement is a perfect fit. Inevitably, I think all partial knees will be done in an ASC at some point in the future." Robotic technology is now used in around 15 percent of partial knee replacements. A recent BCC Research report estimates the medical robotics and computer-assisted surgical technologies market will reach $4.6 billion in 2019, growing at a five-year com- pound annual growth rate of 7 percent. The United States is ex- pected to account for 75 percent of the market by 2019. n "The robotic technology has allowed us to perform surgery more precisely, more accurately and have greater reproducibility; therefore, as physicians, we want to use it." – Dr. Arthur Ting, Orthopedic Surgeon in Fremont, Calif. Blue Belt Technologies is the manufacturer of the Navio ® Surgical System and STRIDE™ Unicondylar Knee System. Navio is a robotics-assisted smart surgical system indicated for unicondylar knee replacement. Through a CT-free approach, Navio enables kinematic and anatomic registration, sophisticated implant planning with soft-tissue balancing techniques, and robotics-assisted bone preparation for precise and repeatable results.

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