LEWISTON – Soon operated? A robot can probably help with this.
Robotic-assisted technology is becoming more common in Maine operating rooms, with St. Mary’s Regional Medical Center in Lewiston recently joining the list of hospitals using the new methods.
“It’s kind of a fundamentally different way to do knee replacement surgery,” Dr. Boris Kovalenko, an orthopedic surgeon at St. Mary’s, said earlier this summer.
Kovalenko stood in an operating room at St. Mary’s, holding what looked more like a booby-trapped hot glue gun attached to a rolling TV cart than advanced surgical technology.
While some surgical robots, like the Da Vinci models found at Central Maine Medical Center in Lewiston, Maine Medical Center in Portland, and elsewhere in the state, are large machines capable of performing multiple types of surgery, the CORI robot is specially designed for total operations and partial knee arthroplasty or knee arthroplasty.
With the robot, “we are able to basically use this technology to determine what the patient’s native anatomy is, determine what their anatomy is (knee bones), their soft tissue anatomy, and use that to determine how optimal positioning of these implants,” said Kovalenko.
“Because everyone’s knee is unique, so we’re allowed to figure out what’s the best way to cut the bone and put the implant in.”
In a traditional knee replacement, a surgeon makes preliminary cuts, places trial implants, and flexes and extends the knee to find the right “balance” of tension on the ligaments that surround the knee, before replacing the ends of the knee joints. thigh and tibia bones and part of the patella, Kovalenko said.
Thanks to sensors placed in the knee, the robot can graphically represent the balance of the knee while Kovalenko is working. There are also fewer incisions and small cuts.
The Da Vinci models used by CMMC and Maine Med are bulky machines compared to the small portable device at St. Mary’s.
As Kovalenko stands over a patient and has the robot in hand, surgeons using the Da Vinci stand somewhat distant from the patient – seated a few feet from a huge console, from where they view the 3D view high definition of the operating field from the machine’s cameras and direct its robotic arms.
“The greatest thing about robotics for me, when you apply it to really any area of surgery, is the level of precision with which you can dissect,” said bariatric surgeon Dr. Blair Baldwin. at the CMMC.
“If you look at the tip of your pen or your pencil and we think about how small that little area is, it’s kind of the size of the tips of the instruments that we work with, with robotic surgery.”
Successful surgery requires the skilled hands of a surgeon, Baldwin said, “but smaller, more precise hands are even better. And that’s why I love it.
This type of surgery, where the surgeon operates the machine from a separate console, takes some getting used to, according to Maine Med urologist Dr. Matthew Hayn.
With the robot, “it’s a different experience,” Hayn said. “You can’t feel anything with robots. There’s no tactile feedback, no haptic feedback, so you kind of have to train your brain to trust how things look when you’re shooting, like these visual cues.
Feel is important to a surgeon, often because the surgical field is not so easy to see.
“You see things robotically better,” Hayn said, “and you see everything magnified and in 3D, which in my mind kind of makes up for that lack of ability to feel. It’s a trade-off. But once you learn how to do it, it doesn’t matter.
While the level of precision and the minimally invasive approach to the surgery are huge pluses for these surgeons, they aren’t quite convinced it’s better than the “old fashioned way.”
“I think I can do a good knee replacement anyway,” Kovalenko said, and it’s not necessarily faster.
Baldwin said he fears that overreliance on new technologies, especially as it continues to develop, will mean the loss of the patient-provider connection, which he says is particularly important during recovery.
This technology is also expensive. The Da Vinci robot cost around $2 million in 2020, according to the scientific journal Nature.
Hayn said robotic-assisted technology is a “game changer,” especially in urology, where some open surgeries come with a high risk of blood loss and longer post-operative hospital stays.
“It allows us to convert some cases that could only be done open-ended,” Hayn said, “to now minimally invasive just because of the kind of nuances of how the robot works.”
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