AMP News Health & Science July 2018

Dr. Robot

Doctor with robot
Doctor with robot

Dr. Mustain. Photo courtesy of UAMS Communications


July 2018 Issue

Arkansas hospitals are turning to advanced technology in the surgical room

by Curtis Lanning

It’s no longer the stuff of science fiction: Robots are stepping into the medical field, as hospitals in Arkansas bring in new technology to aid surgeons in the operating room.

Conan Mustain, M.D., at the University of Arkansas for Medical Sciences (UAMS) in Little Rock has been using robots in the operating room since 2015. Dr. Mustain trained using the da Vinci Xi Surgical System at a hospital in Cleveland and now uses it in Little Rock.

He admits he was initially a little concerned about using the new tool.

“I didn’t feel my comfort level was as high,” Mustain recalls.

But in the end, it was wanting to keep his robotic surgery credentials that got Mustain to dive into the new technology. And now he’s performed several operations with the da Vinci Xi Surgical System, coming to see several key advantages the new technology offers him.

“My enthusiasm for it has gone up,” he says.

Mustain uses the device for colon and rectal surgery, as it allows him control of a camera, a 3D imaging display and use of three robotic arms, all of which come in handy when operating on such a tightly confined area, he says.

Say a patient needs a radical prostatectomy (removal of a prostate) due to cancer. The gland is particularly difficult to get at, and according to Mustain, before using robotic assistance, the operation was technically challenging, as doctors had to juggle more instruments than hands.

Now, with the da Vinci Xi Surgical System, Mustain has more ease of movement.

“I can almost instantly toggle within instruments,” he says.

Mustain believes robotic-assisted surgeries will only increase as time goes on and technology advances.

“I think it’s here to stay,” he asserts, adding his prediction that as more companies develop robots to assist with surgery, the machines will find their way into more hospitals and operations.

“I think that’ll increase market competition and drive down price.”

But when it comes to surgeries that are done solely by machines, Mustain says that will likely remain in the realm of science fiction due to the variation of human anatomy. Put simply? Everyone’s body is too different, and a robot is just an extension of a surgeon, according to Mustain.

What he does believe will come eventually is remote surgery, where the operating surgeon isn’t even in the same location as the patient.

UAMS isn’t the only Arkansas hospital using robotic systems to assist with surgery. Less than five miles away, Baptist Health Medical Center has orthopedic surgeons using Mako Robotic-Arm Assisted Technology.

Doctor in scrubs

Dr. Nix. Photo by David Yerby.

Richard Nix, M.D., has performed 40 robotic partial and total knee replacements using Mako. Baptist brought Mako online in February, says Dr. Nix, who likens Mako to factory assembly-line robotic arms designed for maximum precision.

Nix says the robot allows for “extremely exact” operative abilities that are accurate to a fraction of a millimeter when doing a knee replacement. And it’s that precision, he notes, that is the real advantage of the machine.

Before the surgery even begins, Nix and his team perform a preoperative CT scan of the knee they’ll be performing surgery on. A computer then builds a 3D model of the knee, and Nix and his team can rotate, flip and look at everything from multiple angles, giving them the best view to plan the operation from.

It’s this pre-cut prep work that really makes a difference in the operation, according to Nix. The data is collected, loaded into a computer and then executed in surgery.

Once the operation begins, Nix says he can use Mako to adjust ligament tension and components of the knee replacement one millimeter at a time. The goal is to ensure as long a life for the implants as possible, so the patient has the best outcome.

Like Mustain, Nix sees robotic-assisted surgeries increasing in the future.

“They will expand robotics in other ways,” Nix says, speaking about how companies are competing to develop new medical technology.

Nix says other surgeries, like shoulder replacements, may soon have robotic assistants, too.

Both doctors agree that patient reaction to the robots ranges from indifferent to excited.

Mustain says his Arkansas patients are indifferent about being operated on with a robot — a reaction he attributes in part due to the fact that the robot is likely being used to remove cancer. His patients in Cleveland were a bit more excited, but overall, he says, patients are happy he can use a robot to assist with surgery if it helps the operation.

Nix says his patients are “giddy” about robot-assisted surgery. They might have seen Mako in a commercial and are excited to learn it’ll be used for their knee replacement, he notes. “The proof is in the patient response,” he says.

Nix’s patients sense the more efficient mechanical precision Mako offers, and they’re delighted, he says.

Once he switched over to using Mako and saw the patient reaction, he says, “This is the way to go,” adding: “It’s hard to go back to a less precise way.”

Still, while both doctors have seen positive results with their robot-assisted surgeries, other doctors still choose not to use the machines while performing surgery.

Doctor with arms crossed

Dr. Barnes. Photo by Jamison Mosley.

Lowery Barnes, M.D., specializes in hip and knee replacement at UAMS, and he is concerned that there isn’t enough data to support claims that robot-assisted surgery makes a huge difference, at least in the way of orthopedics.

Dr. Barnes, an experienced surgeon, says robots used in orthopedic surgeries are often advertised to make smaller incisions, cause less pain and lead to faster recovery times for patients. But he doesn’t believe the evidence is there to support those claims.

According to Barnes, robots haven’t changed the operation of knee replacement. And patients may not understand that robot-assisted surgery in orthopedics isn’t necessarily an advancement, it’s just an alternative, he says.

And at the end of the day, if patients come to Barnes and request robot-assisted orthopedic surgery, he tells them he doesn’t offer it. He says he’s not jumping on that bandwagon just yet. He has developed a highly regarded reputation for hip and knee replacement, adding that he’s gotten good results without using robots to assist him in the operating room.

“The bond has to be between a patient and surgeon, not patient and robot,” he says.

But Nix believes robot-assisted surgery does make a difference, and says there’s enough evidence to show that. He explains that he no longer has to drill holes in bones, and the smaller incisions from Mako lead to less bruising and a faster rehabilitation.

To top it off, patients who have had one knee replaced without the assistance of a robot and one with a robot tell Nix there’s a big difference and that the robot-assisted knee replacement is better.

There are no real convincing studies that show surgery is done any better with a robot, unless it enables the doctor using it to operate better, says Mustain. “You have to be judicious.”

And Barnes isn’t opposed to bringing new technology into the operating room. In fact, he says he was one of the first doctors in Arkansas to buy computer-assisted surgery equipment 15 years ago when he was in private practice. He made the purchase to gather data.

“Technology can make a big difference,” he says, but he’s waiting on more data to come in on robot-assisted surgery in orthopedics.

Barnes may even be willing to use robot-assisted surgery in the future. “We may get there,” he says.

Before Nix performed robot-assisted surgery on a regular basis, he was skeptical. In fact, he even offered to compare his old X-rays to patients who’d had robot-assisted surgery. But eventually, he says, he had to eat his words as he came to see that robotic results were reassuring for the life of the implants.

Mustain doesn’t have much concern for the future of robots in the surgical room — with one exception. He does worry there’s a chance some doctors will start using robots for less complicated operations, and then there may be a risk of those doctors becoming dependent on the machines.

When all is said and done, Drs. Barnes, Mustain and Nix agree that their biggest focus is on patient care, whether robots are present in the operating room or not.

“It’s all about the patient and doing the best you can do,” says Barnes. “A surgeon who uses a robot is not a bad surgeon.”

Barnes says patients just need to be confident in their surgeon. If they’re having orthopedic surgery, they’ll want someone who has performed plenty of hip and knee replacements, according to Barnes.

Mustain says a robot is a tool, like a scalpel or retractor. Ultimately, doctors shouldn’t let technology drive decision making.

“I’m choosing their surgical approach with the goal of maximum benefit to the patient,” Mustain says.

If a robot can perform an operation with less pain for the patient and get them back to work faster, great, use it, Mustain says.

Nix says patient reaction tells him he’s going in the right direction. He wants good X-rays and precision in the operating room.

Nix says, “The things we’re looking for are safety and good outcomes.”

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