OTW: Image-based navigation—tying in with some imaging source?
Dr. Goldstein: Fluoroscopy is tied in with imaging source, but using an image guided robot allows for increased precision and accuracy and smaller incisions, faster surgical time, less blood loss, potentially better outcomes. Certainly, at the top of the list is less radiation for the surgeon as well as the staff and the patient. More precision, greater accuracy, faster/less radiation.
OTW: When you saw the early spine robotic systems—the little Coke can…
Dr. Goldstein: I always saw pictures of it in a green light, so I thought it looked more like a 7-Up can.
OTW: Did you think this would reduce radiation, improve precision through smaller incisions?
Dr. Goldstein: I thought it would just slow me down. I just couldn’t grasp how it would fit into my practice.
OTW: Do you think the growth of minimally invasive surgery in your practice was a significant driver to your eventual adoption of robots?
Dr. Goldstein: I have always done degenerative surgeries and as those surgeries became more minimally invasive, the robot gave me the opportunity to do them better.
OTW: Mazor pioneered spine surgery robots. But there are new entrants most notably ROSA (Zimmer Biomet) and ExcelsiusGPS (Globus Medical, Inc), for example. Have you had a chance to use either of these new entrants? What are you finding so far?
Dr. Goldstein: I’ve explored Mazor’s robot and Globus’ Excelsius GPS. We adopted the Excelsius. Excelsius offers the opportunity to do minimally invasive surgery with a robot with navigation and not absolutely require preoperative CT scan. I can certainly get a preoperative CT scan, but if I prefer intraoperative fluoroscopy or intraoperative CT, or intraoperative simulated CT, then I can.
OTW: How user friendly is the preop software?
Dr. Goldstein: The preoperative/intraoperative software is very intuitive. If you can use an iPad you can use the software. If you like to play video games—we don’t want to call this a video game—but it’s very intuitive.
OTW: Is it as good as solitaire?
Dr. Goldstein: While I don’t play a lot of video games, my son, who was at ISASS a year ago, had the opportunity to play with the software and it was very intuitive to him.
OTW: How old is your son?
Dr. Goldstein: He’s 9. That’s what I mean by software is very user friendly.
OTW: When you and NYU decided to take the plunge into robotics, what drove the decision?
Dr. Goldstein: I think for me it was the navigation and the opportunity to be able to plan my surgery without absolutely needing a preoperative CT scan.
OTW: Is that a big deal?
Dr. Goldstein: It is nice to have options and flexibility. Other systems require pre-op CT scans. There are certainly benefits to using pre-op CT scans inasmuch as you preplan your surgery. And with a few fluoro shots in the OR you can match your positioned patient to the pre-op CT scan. This helps with workflow and reduces fluoro exposure in the OR. Alternatively, if you do not have a preop CT completed per protocol, with our robot system we can still use the intra-op fluoro, intra-op CT, or intra-op simulated CT.
