“In a properly automated and educated world, then, machines may prove to be the true humanizing influence. It may be that machines will do the work that makes life possible and that human beings will do all the other things that make life pleasant and worthwhile.”
― Isaac Asimov, "Robot Visions"
Imagine GPS tracking -- not unlike the kind that directs your course in your vehicle -- and robotic "arms" and "eyes" surgically relieving your chronic back pain.
But then again, you need not have to imagine it; the concept is now science fact instead of science fiction in CAMC operating theaters, where surgeons are employing the Mazor X Stealth Edition robotic guidance system to alleviate or eliminate patients' back-related conditions.
The Mazor X Stealth Edition uses software to plan the surgical procedure, and markers and a robotic arm to guide implants and instruments through the procedure, providing real-time imaging feedback simultaneously. The software, using computer vision segmentation algorithms, is able to recognize different anatomical structures and, consequently, designate the path lines for the surgical instruments to follow.
Aided by the Mazor X Stealth Edition's 3D software and GPS capabilities, CAMC physicians are able to perform less invasive surgery for spinal conditions. This enables a greater level of precision and predictability to the procedures in the process.
The robotics-guided technology at CAMC is used for a number of spinal procedures, including, but not limited to:
• scoliosis (or curvature) of the spine
• herniated discs
• degenerative disc disease
• vertebral fractures
• spondylosisthesis (a condition affecting the lower vertebrae)
• stenosis (a narrowing of the spaces within the spine).
CAMC has become the first medical facility in the southern part of the state to offer the robotic-guided technology for spine surgeries. Cleared by the U.S. Food and Drug Administration in November 2018, the Mazor X Stealth robotic-assisted spinal surgery system became available in the United States last year through Minnesota-based Medtronic, the world's largest maker of medical devices.
Medtronic developed the system in collaboration with Mazor Robotics, an Israeli company it purchased for $1.7 billion in September 2018, and introduced the Mazor X Stealth Edition four months afterward.
Domestically, the system's initial uses took place at Norton Healthcare in Louisville, Kentucky, and the Reston Hospital Center in Reston, Virginia. Since then, more than 1,000 procedures have taken place at more than 50 hospitals around the nation, including CAMC.
Mapping out procedures
"This technology allows us to create a surgical blueprint for each patient before we ever go into the operating room,” CAMC neurosurgeon and spine surgeon Dr. John Orphanos said. “We literally create a map of your spine and plan each step of your surgery that’s specific to your anatomy, just like you use GPS to plan a route when you travel.
"This technology brings an entirely new level of accuracy to delicate back surgeries. For patients, it means less pain, less time under anesthesia, less radiation exposure, smaller incisions, shorter recovery time and fewer complications, which all lead to a faster recovery and return to daily activities,” Orphanos said.
He said he and his colleagues have performed approximately a dozen Stealth-assisted surgeries at CAMC since December, following mandatory training. "They basically train us on the machine and the techniques," he said. "We do a lot of work with Medtronic to get those techniques down. They have a support team who will help us with the software and the nuts and bolts, things you have to learn as you go.
"In the pantheon of spine surgery, especially over the course of my career - which is about almost 10 years of practice and about another seven years of training - we've seen a lot of growth of the field, the techniques and the technology," Orphanos said. "A lot of the techniques we use really haven't been around that long, either.
"The natural evolution of what that technology has become is that it's become a less invasive type of thing," he said. "Over the last 10 or 12 years, we've seen a lot of growth in trying to make incisions smaller, trying to make operations shorter, trying to make blood loss less, trying to decrease the recovery time and trying to do more through a lot smaller space."
Orphanos said the field has also expanded through computer navigation, producing intraoperative images. "We have these computers that see the patient and can actually direct us where we are, in the spine, in the brain. Those changes in navigation have been some of the most important advancements in neurosurgery, in helping us make these surgeries a lot safer."
"Living with back pain can be debilitating," Dr. Lana Christiano, a CAMC neurosurgeon and spine surgeon said in a CAMC release, "and recovering from spine surgery was once a long process.
"By combining robotics and navigation, we are excited to offer patients a better solution that reduces their recovery time after surgery and greatly improves their quality of life,” Christiano said.
"For more than 30 years, CAMC has been a leader in minimally invasive surgery, and this technology enhances the ability of our skilled spine surgeons to safely perform the most advanced procedures,” CAMC President and CEO Dave Ramsey added.
Additional information about robotic-guided spinal surgery at CAMC can be found at camc.org/BackSurgery.
Robotics to detect lung cancer risks
Along with other robotic technology on site, earlier this year, the CAMC medical staff began using another new technological innovation that could provide exceptional benefits in fighting lung cancer.
The Monarch Platform from Auris Health is used to view the interior of the lungs and obtain a tissue sample for biopsies. Its technical capabilities are intended to enable earlier, more precise diagnoses of small and hard-to-reach nodules in the periphery of the patient's lung.
The technology integrates robotics, software, data science and endoscopy (the use of small cameras and tools to enter the body through its natural openings). The Monarch Platform combines three navigation technologies – electromagnetics, optical pattern recognition and robotic kinematic data – to triangulate bronchoscope location during the procedure and provide accurate positional data to physicians performing a bronchoscopy.
Putting the technology into practice in February, CAMC is one of the first hospitals in the United States to use the platform, which was approved late last year by the U.S. Food and Drug Administration.
“This is a brand-new era in pulmonary medicine and we're really excited about it,” CAMC pulmonologist Tom Takubo said in a CAMC article. “We can steer the robot and see into these deep recesses of the lungs that we've actually never seen ourselves before. We should be able to get to these lesions, biopsy them and find out if this is something bad or not without having to do more invasive procedures where someone would have to be surgically opened.”
The Monarch Platform functions with a controller-like interface, which Takubo and his CAMC colleagues use to navigate the flexible robotic endoscope to the periphery of the lung. It merges traditional endoscopic views into the lung with computer-assisted navigation based on 3D models of the patient’s own lung anatomy.
The Monarch Platform gives physicians bronchoscope vision throughout the entire procedure. This robotic technology allows greater vision and control for bronchoscopic procedures than traditional methods have or can. It can be beneficial in detecting and diagnosing lung cancer sooner, as lung cancer often has no symptoms during its early stages.
“Unfortunately, right now, if you are diagnosed with lung cancer, there's only about a 15% chance for survival,” Takubo said.
In practice, electromagnetic navigational bronchoscopy is coupled with live camera feedback. Takubo said this robot-assisted capability permits him to see all the way to the lining of the lung in many instances, with the camera feedback guiding him to a more precise biopsy.
“The hope with this new technology and robotics that we have here at CAMC is that we'll be able to navigate out to these lesions and diagnose them at a much earlier stage than what we've ever been able to do in the past and shift the diagnosis more to early-stage lung cancer than late stage. We know that if you catch lung cancer early in stage 1 or 2, the chance of survival goes up to 88% to 92%,” he said.
A short video of Takubo describing the procedure can be viewed online by going to YouTube and searching for "CAMC robotic bronchoscopy."
The rise of the robots
“The marriage of robotics and navigation represents the future of computerized planning and execution in spine surgery,” Dr. Christopher Good of Reston Hospital Center and the Virginia Spine Institute said in a January TheRobotReport.com article.
CAMC surgeons concur.
"One of my old professors always referred to spine surgery as having to carry a big toolbox," Orphanos said. "There are a lot of tools you put into this box, and you'll find the tools that help you the most and those that don't, but they all have a role.
"The robot is another tool that has a lot of potential to grow," he said. "We've seen it in its application and it does work. Obviously, whenever you're using something new, it takes time to get the process down, but, in terms of its execution, it does very well.
"I think, over time, what we'll see is streamlining the process, its application growing; right now it's mostly for lumbar surgery. Over time, that will also expand.
"It's possible every case will involve some type of robotics. That's what's kind of cool and exciting about it," Orphanos said.
He anticipates the next step in the medical/technical evolution will be robot-assisted surgery.
"Artificial Intelligence and all these other things that go into robotics are growing fields," he said. "The systems that we have currently are assisting devices; they aren't doing anything. It's us programming them to do what they're doing. Essentially, what the robot is doing now is helping us place our screws by finding the trajectories of the spine and aiding us in making screw placement safer, in combination with navigation.
"I think where we're at with robotics right now is kind of like the ground floor. I thought it was important for CAMC to invest in these kind of technologies. It will grow and become more refined, more advanced and more helpful as time goes by. Probably 10 years from now, we're going to have a totally different conversation about what we can do."
Dr. Samuel Deem, CAMC's director of robotic surgery, said CAMC has been using robotic technology in various departments for the past 13 years.
"It started in 2007, mainly with robotic prostatectomies," Deem said, "and we've expanded it to pretty much every surgical specialty at CAMC. It's been used in gynecology, and, more recently, our cardiothoracic surgeons are doing one-vessel cabbages (the pronunciation for CABGs, or Coronary Artery Bypass Surgeries) with it.
Deem specializes in urologic oncology and said he and his CAMC colleagues have employed robotics in more than 3,000 procedures for kidney, prostate and other treatments.
"It gives us 3D high definition, better than any television screen," he said. "We used to bluntly dissect with our hands, and now we can see tissue as we dissect with much more precision. It's night and day compared to the former surgery."
Deem added that CAMC will be considered soon for a Robotics Center of Excellence designation.
"We're having our evaluation on April 26," he said, "and we think we're definitely going to be one of the Robotics Centers of Excellence after that meeting."
"
― Isaac Asimov, "Robot Visions"
Imagine GPS tracking -- not unlike the kind that directs your course in your vehicle -- and robotic "arms" and "eyes" surgically relieving your chronic back pain.
But then again, you need not have to imagine it; the concept is now science fact instead of science fiction in CAMC operating theaters, where surgeons are employing the Mazor X Stealth Edition robotic guidance system to alleviate or eliminate patients' back-related conditions.
The Mazor X Stealth Edition uses software to plan the surgical procedure, and markers and a robotic arm to guide implants and instruments through the procedure, providing real-time imaging feedback simultaneously. The software, using computer vision segmentation algorithms, is able to recognize different anatomical structures and, consequently, designate the path lines for the surgical instruments to follow.
Aided by the Mazor X Stealth Edition's 3D software and GPS capabilities, CAMC physicians are able to perform less invasive surgery for spinal conditions. This enables a greater level of precision and predictability to the procedures in the process.
The robotics-guided technology at CAMC is used for a number of spinal procedures, including, but not limited to:
• scoliosis (or curvature) of the spine
• herniated discs
• degenerative disc disease
• vertebral fractures
• spondylosisthesis (a condition affecting the lower vertebrae)
• stenosis (a narrowing of the spaces within the spine).
CAMC has become the first medical facility in the southern part of the state to offer the robotic-guided technology for spine surgeries. Cleared by the U.S. Food and Drug Administration in November 2018, the Mazor X Stealth robotic-assisted spinal surgery system became available in the United States last year through Minnesota-based Medtronic, the world's largest maker of medical devices.
Medtronic developed the system in collaboration with Mazor Robotics, an Israeli company it purchased for $1.7 billion in September 2018, and introduced the Mazor X Stealth Edition four months afterward.
Domestically, the system's initial uses took place at Norton Healthcare in Louisville, Kentucky, and the Reston Hospital Center in Reston, Virginia. Since then, more than 1,000 procedures have taken place at more than 50 hospitals around the nation, including CAMC.
Mapping out procedures
"This technology allows us to create a surgical blueprint for each patient before we ever go into the operating room,” CAMC neurosurgeon and spine surgeon Dr. John Orphanos said. “We literally create a map of your spine and plan each step of your surgery that’s specific to your anatomy, just like you use GPS to plan a route when you travel.
"This technology brings an entirely new level of accuracy to delicate back surgeries. For patients, it means less pain, less time under anesthesia, less radiation exposure, smaller incisions, shorter recovery time and fewer complications, which all lead to a faster recovery and return to daily activities,” Orphanos said.
He said he and his colleagues have performed approximately a dozen Stealth-assisted surgeries at CAMC since December, following mandatory training. "They basically train us on the machine and the techniques," he said. "We do a lot of work with Medtronic to get those techniques down. They have a support team who will help us with the software and the nuts and bolts, things you have to learn as you go.
"In the pantheon of spine surgery, especially over the course of my career - which is about almost 10 years of practice and about another seven years of training - we've seen a lot of growth of the field, the techniques and the technology," Orphanos said. "A lot of the techniques we use really haven't been around that long, either.
"The natural evolution of what that technology has become is that it's become a less invasive type of thing," he said. "Over the last 10 or 12 years, we've seen a lot of growth in trying to make incisions smaller, trying to make operations shorter, trying to make blood loss less, trying to decrease the recovery time and trying to do more through a lot smaller space."
Orphanos said the field has also expanded through computer navigation, producing intraoperative images. "We have these computers that see the patient and can actually direct us where we are, in the spine, in the brain. Those changes in navigation have been some of the most important advancements in neurosurgery, in helping us make these surgeries a lot safer."
"Living with back pain can be debilitating," Dr. Lana Christiano, a CAMC neurosurgeon and spine surgeon said in a CAMC release, "and recovering from spine surgery was once a long process.
"By combining robotics and navigation, we are excited to offer patients a better solution that reduces their recovery time after surgery and greatly improves their quality of life,” Christiano said.
"For more than 30 years, CAMC has been a leader in minimally invasive surgery, and this technology enhances the ability of our skilled spine surgeons to safely perform the most advanced procedures,” CAMC President and CEO Dave Ramsey added.
Additional information about robotic-guided spinal surgery at CAMC can be found at camc.org/BackSurgery.
Robotics to detect lung cancer risks
Along with other robotic technology on site, earlier this year, the CAMC medical staff began using another new technological innovation that could provide exceptional benefits in fighting lung cancer.
The Monarch Platform from Auris Health is used to view the interior of the lungs and obtain a tissue sample for biopsies. Its technical capabilities are intended to enable earlier, more precise diagnoses of small and hard-to-reach nodules in the periphery of the patient's lung.
The technology integrates robotics, software, data science and endoscopy (the use of small cameras and tools to enter the body through its natural openings). The Monarch Platform combines three navigation technologies – electromagnetics, optical pattern recognition and robotic kinematic data – to triangulate bronchoscope location during the procedure and provide accurate positional data to physicians performing a bronchoscopy.
Putting the technology into practice in February, CAMC is one of the first hospitals in the United States to use the platform, which was approved late last year by the U.S. Food and Drug Administration.
“This is a brand-new era in pulmonary medicine and we're really excited about it,” CAMC pulmonologist Tom Takubo said in a CAMC article. “We can steer the robot and see into these deep recesses of the lungs that we've actually never seen ourselves before. We should be able to get to these lesions, biopsy them and find out if this is something bad or not without having to do more invasive procedures where someone would have to be surgically opened.”
The Monarch Platform functions with a controller-like interface, which Takubo and his CAMC colleagues use to navigate the flexible robotic endoscope to the periphery of the lung. It merges traditional endoscopic views into the lung with computer-assisted navigation based on 3D models of the patient’s own lung anatomy.
The Monarch Platform gives physicians bronchoscope vision throughout the entire procedure. This robotic technology allows greater vision and control for bronchoscopic procedures than traditional methods have or can. It can be beneficial in detecting and diagnosing lung cancer sooner, as lung cancer often has no symptoms during its early stages.
“Unfortunately, right now, if you are diagnosed with lung cancer, there's only about a 15% chance for survival,” Takubo said.
In practice, electromagnetic navigational bronchoscopy is coupled with live camera feedback. Takubo said this robot-assisted capability permits him to see all the way to the lining of the lung in many instances, with the camera feedback guiding him to a more precise biopsy.
“The hope with this new technology and robotics that we have here at CAMC is that we'll be able to navigate out to these lesions and diagnose them at a much earlier stage than what we've ever been able to do in the past and shift the diagnosis more to early-stage lung cancer than late stage. We know that if you catch lung cancer early in stage 1 or 2, the chance of survival goes up to 88% to 92%,” he said.
A short video of Takubo describing the procedure can be viewed online by going to YouTube and searching for "CAMC robotic bronchoscopy."
The rise of the robots
“The marriage of robotics and navigation represents the future of computerized planning and execution in spine surgery,” Dr. Christopher Good of Reston Hospital Center and the Virginia Spine Institute said in a January TheRobotReport.com article.
CAMC surgeons concur.
"One of my old professors always referred to spine surgery as having to carry a big toolbox," Orphanos said. "There are a lot of tools you put into this box, and you'll find the tools that help you the most and those that don't, but they all have a role.
"The robot is another tool that has a lot of potential to grow," he said. "We've seen it in its application and it does work. Obviously, whenever you're using something new, it takes time to get the process down, but, in terms of its execution, it does very well.
"I think, over time, what we'll see is streamlining the process, its application growing; right now it's mostly for lumbar surgery. Over time, that will also expand.
"It's possible every case will involve some type of robotics. That's what's kind of cool and exciting about it," Orphanos said.
He anticipates the next step in the medical/technical evolution will be robot-assisted surgery.
"Artificial Intelligence and all these other things that go into robotics are growing fields," he said. "The systems that we have currently are assisting devices; they aren't doing anything. It's us programming them to do what they're doing. Essentially, what the robot is doing now is helping us place our screws by finding the trajectories of the spine and aiding us in making screw placement safer, in combination with navigation.
"I think where we're at with robotics right now is kind of like the ground floor. I thought it was important for CAMC to invest in these kind of technologies. It will grow and become more refined, more advanced and more helpful as time goes by. Probably 10 years from now, we're going to have a totally different conversation about what we can do."
Dr. Samuel Deem, CAMC's director of robotic surgery, said CAMC has been using robotic technology in various departments for the past 13 years.
"It started in 2007, mainly with robotic prostatectomies," Deem said, "and we've expanded it to pretty much every surgical specialty at CAMC. It's been used in gynecology, and, more recently, our cardiothoracic surgeons are doing one-vessel cabbages (the pronunciation for CABGs, or Coronary Artery Bypass Surgeries) with it.
Deem specializes in urologic oncology and said he and his CAMC colleagues have employed robotics in more than 3,000 procedures for kidney, prostate and other treatments.
"It gives us 3D high definition, better than any television screen," he said. "We used to bluntly dissect with our hands, and now we can see tissue as we dissect with much more precision. It's night and day compared to the former surgery."
Deem added that CAMC will be considered soon for a Robotics Center of Excellence designation.
"We're having our evaluation on April 26," he said, "and we think we're definitely going to be one of the Robotics Centers of Excellence after that meeting."
"
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