Choosing a Second-Generation Robotic System
When Dr. Manista decided to move from a first generation to a second-generation system, he initially headed to the Mazor X.
“When it came time to upgrade our system, I assumed we would just go for the Mazor X. We asked for Medtronic’s best deal, which they gave us but before we got an ‘ok’ from our hospital, they said, “The Medtronic’s deal is doable, but just to be thorough, what else is out there?”
“I went out to look at Globus’s robot in Philadelphia and I came away from that visit going, “Wow!” All the things I had wanted in a Gen 2 robot were already there. And you’ve got to keep in mind this was a couple of years ago, and the Mazor X did not have any navigation at that time. I walk into Globus and boom it’s there. It was incredibly easy to program. And fast.”
Third and Fourth Gen Robotic Systems
“The third-generation robots, in my definition, is where you can program the robot to do something, punch a button, or pedal, and then the robot will perform that task exactly as you told it to do. I think Gen 3 is where I program in “I want to do a laminectomy, and I want it to be 3mm away from this recognizable boney segment and 5mm from this recognizable boney segment. And I want a depth of ‘x’ millimeters and in one piece. I’m there, I’m present, but not actually doing it.”
“I want to be clear I’m not sharing any sensitive information or corporate secrets or any of that. This is Andy Manista’s opinion about where I think the technology should go. As for Gen 4, it would be like the movie “Alien: Covenant” (https://www.youtube.com/watch?v=svnAD0TApb8) where the lady is injured. She gets into a tube. It scans her body and then performs an operation on her. Start to finish.”
How Has Robotic Assist Changed the Practice of Spine Surgery?
We asked this question of both surgeons and Dr. Manista brought up a very specific procedure—the lateral approach spine surgery.
“I’ve been a fan of lateral for a long time. I get revision patients with subsided PEEK implants and I find that the lateral approach is a pretty powerful technique. But fixation is the biggest challenge. So, Globus came to me and said and we can do lateral cases with the Excelsius’s robotics with navigation system.”
Unexpected. Traditionally, with the kind of complex cases Dr. Manista takes on, patients stay in the hospital two days.
The Excelsius changed that.
As Dr. Manista explained to OTW, “Now, with the Excelsius system, our typical lateral patients stay overnight. With the Excelsius free arm, it doesn’t matter what position the patient is in, the screws are placed accurately, reproducibly. Using the Excelsius in one of my lateral revision cases, I had one of the epiphanies, I’ll never go back to free-hand lateral. Same surgery—lateral approach with pedicle screws—but in half the time and less positioning.”
Robotic Systems Are Wearing Well
It is notable that, instead of weakening their appeal, the longer these two surgeons used robotic assist systems—notably the ones that combine navigation and robotic arms like Globus’ Excelsius, the more they liked them, the increasing variety of cases where they employed them and the perception that error rates and hospital stays have declined sharply.
And, we’re only on Gen 2.
Stay tuned, for sure.
