Junqing Lin1,2
Hongyi Zhu1,2*
- 1Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2National Center for Orthopaedics, Shanghai, China
Editorial on Research Topic
“The dawn of future orthopaedic surgery: intraoperative navigation and robotic assistance”
Recently, the efficacies of many classic surgeries (1–3) have been greatly challenged by high-level evidence. In my understanding, every surgical procedure has two sides, yin and yang. For the yang side, the procedure could directly bring therapeutic effects to patients via invasive manipulation. In contrast, for the yin side, invasive procedures would inevitably cause Iatrogenic injury to patients as well. Technological innovation in orthopedics is still relatively slow. Since the emergence of the Da Vinci surgical robot, robotic minimally invasive surgery has been a hot topic pursued by various departments (4). Robotic orthopedic surgeries are a New Hope for musculoskeletal and sports medicine, just as the role of Luke Skywalker for the galaxy (5).
In recent years, many orthopedic surgical robots have emerged in the field of orthopedics for clinical applications, including MAKO (6) and NAVIO (7) surgical robots represented by joint replacement surgery, as well as MAZOR (8) surgical robots represented by spine surgery. The use of surgical robots in orthopedic procedures has improved precision and minimized invasiveness. Although these robots have injected new vitality into the improvement of orthopedic surgical techniques and enabled a certain degree of precision and efficacy enhancement, their application has not been widely used despite almost 40 years of development since their first use in orthopedics in 1986 (5). In contrast, the da Vinci surgical robot has been widely used in various fields since its first clinical use in 1997, owing to its high-resolution three-dimensional imaging system and precise mechanical arm controller. The da Vinci surgical robot can accurately achieve therapeutic goals under minimally invasive conditions, significantly improve efficacy, reduce the risk of postoperative complications, and shorten hospitalization time (9). These observations suggest that numerous deficiencies in orthopedic surgical robots have limited their development in the past decade.
The final acceptance of robotic surgery in general orthopedic surgery depends on its cost-effectiveness. In contrast to the da Vinci robotic system, the cost of robotic surgery is notably higher. Different types of prostheses and equipment may have different robots available, which further increases the cost of surgery. Moreover, there is currently no evidence that this increase in cost can bring benefits to patients sufficient enough to balance out this cost (10). Many orthopedic surgical robots require a lot of time to process data and locate before surgery, making the surgical procedure extremely complex, which leads to longer surgery times compared to traditional surgeries, and makes it very difficult for orthopedic surgical robots to be widely promoted (5). In addition, as orthopedic surgical robots are a product of recent years’ development, there is currently a lack of high-quality clinical research evidence on their long-term efficacy. Therefore, the academic community still has many doubts about their effectiveness in treatment. A prospective randomized controlled study conducted by Bell et al. demonstrated that the utilization of the MAKO robotic arm system for unicompartmental knee replacement (UKA) resulted in a significant improvement in surgical precision when compared to conventional surgical procedures (11). However, in contrast, another five-year clinical randomized controlled trial did not find a statistically significant difference in surgical accuracy for UKA between manual and robots (12). This finding aligns with a similar study that compared manual and robotic-assisted UKA. Intriguingly, the same surgeon exhibited higher surgical accuracy with manual surgery as opposed to robot-assisted surgery (13). As a result, there is an ongoing debate in the academic community regarding the potential benefits of using surgical robots for orthopedic surgeries and the precise advantages they may offer to patients.
So far, computer-assisted navigation technology has been widely used in orthopedic surgery, but its application varies among different sub-specialties. With the continuous maturity of technology, more and more joint replacement surgeries are assisted by robots for auxiliary operations. Since 2008, with the increasing trend of technology utilization and more robot systems entering the market, the possibility of using robots in orthopedic surgery is expected to increase (14). However, critical issues must be considered during the research and application process of these devices. It is essential to determine whether surgical robots can genuinely address clinical problems and enhance postoperative efficacy while reducing costs without compromising quality. Only by addressing these critical issues can we ensure that the innovation and progress of robotic devices in future orthopedic surgeries will continue to advance.
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Uzoigwe CE, Kurup H. Nonoperative or surgical treatment of acute achilles’ tendon rupture. N Engl J Med. (2022) 387(1):90–1. doi: 10.1056/NEJMc2206333
2. Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet. (2020) 396(10248):390–401. doi: 10.1016/S0140-6736(20)30931-4
3. Loggers SAI, Willems HC, Van Balen R, Gosens T, Polinder S, Ponsen KJ, et al. Evaluation of quality of life after nonoperative or operative management of proximal femoral fractures in frail institutionalized patients: the FRAIL-HIP study. JAMA Surg. (2022) 157(5):424–34. doi: 10.1001/jamasurg.2022.0089
4. Nath N. A review on how Da vinci surgical system is changing the health care. Paper presented at: the 2nd advanced manufacturing student conference (AMSC22); July 07–08; Chemnitz, Germany (2022).
5. Bargar WL. Robots in orthopaedic surgery. Clin Orthop Relat Res. (2007) 463:31–6. doi: 10.1097/BLO.0b013e318146874f
6. Chun YS, Kim KI, Cho YJ, Kim YH, Yoo MC, Rhyu KH. Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplasty. (2011) 26(4):621–5. doi: 10.1016/j.arth.2010.05.017
7. Bell C, Grau L, Orozco F, Ponzio D, Post Z, Czymek M, et al. The successful implementation of the navio robotic technology required 29 cases. J Robot Surg. (2022) 16(3):495–99. doi: 10.1007/s11701-021-01254-z
8. Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: where are we now? Neurosurgery. (2017) 80(3S):S86–99. doi: 10.1093/neuros/nyw077
9. Noël J, Moschovas MC, Sandri M, Bhat S, Rogers T, Reddy S, et al. Patient surgical satisfaction after da vinci® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis. J Robot Surg. (2022) 16(2):473–81. doi: 10.1007/s11701-021-01269-6
10. Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT open Reviews. (2019) 4(10):611. doi: 10.1302/2058-5241.4.190022
11. Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. JBJS. (2016) 98(8):627–35. doi: 10.2106/JBJS.15.00664
12. Banger M, Doonan J, Rowe P, Jones B, MacLean A, Blyth MJ. Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial. Bone Joint J. (2021) 103(6):1088–95. doi: 10.1302/0301-620X.103B6.BJJ-2020-1355.R2
13. Bush AN, Ziemba-Davis M, Deckard ER, Meneghini RM. An experienced surgeon can meet or exceed robotic accuracy in manual unicompartmental knee arthroplasty. JBJS. (2019) 101(16):1479–84. doi: 10.2106/JBJS.18.00906
Keywords: orthopaedic surgery, robotic surgical, robot-assisted surgery, robot-enhanced procedures, orthopaedic
Citation: Lin J and Zhu H (2023) Editorial: “The dawn of future orthopaedic surgery: intraoperative navigation and robotic assistance”. Front. Surg. 10:1209454. doi: 10.3389/fsurg.2023.1209454
Received: 20 April 2023; Accepted: 6 November 2023;
Published: 17 November 2023.
Edited and Reviewed by: Jaimo Ahn, University of Michigan, United States
© 2023 Lin and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hongyi Zhu NDIwMzA4OTU1QHFxLmNvbQ==