Robotic-assisted surgery (RAS) is an emerging medical technology with the potential to help standardize surgical procedures and enable minimally invasive procedures that may improve patient outcomes and reduce health system costs. In 2018, Medtronic acquired Mazor Robotics and its robotic-assisted surgical platform for spine. Not long after, the company launched the Mazor X™ Stealth Edition, which combines advanced software, robotic technology, navigation, and instrumentation. Here, Medtronic executive Dave Anderson, who helped lead the Mazor acquisition, talks about the future of RAS.
Q: How is RAS evolving and changing the field of medicine?
A: As you look at the evolution of robotics in medical devices, we’re really starting to see its application across a lot of procedures. Yet there’s not a one-size-fits-all approach with RAS. For general surgery, you really need RAS to help with the telemanipulation of tissue. For cranial neurosurgery, accuracy is most important. That’s why we’ve purposefully built RAS solutions for general surgery, spine surgery, and cranial neurosurgery, each with their own requirements.
Q: How can RAS improve outcomes for clinicians, hospitals, and patients?
A: As we think about the future of healthcare and RAS, there are different stakeholders: surgeons, healthcare systems, and patients. For hospitals and surgeons, it’s about standardizing procedures. Our top neurosurgeons today are incredibly effective at what they do. But we know there’s variation from surgeon to surgeon and from procedure to procedure. Robotic-assisted surgery can help standardize procedures, which, at a minimum, will help remove those outlier cases, and minimize complications, revisions, or the need for additional surgery. But over time, we also look to increase our innovation such that it reduces the total procedure time.
For health systems, the ability to eliminate those costly outlier cases and reduce procedure time is what’s really most important from an economic and clinical perspective.
From a patient’s perspective, it’s about having more predictable outcomes.
Q: How is RAS changing the way we approach research and development?
A: At Medtronic, RAS is part of an ecosystem of solutions that also includes interoperative imaging, navigation, and powered instruments. As we think about research and development, we think about innovation. We’re thinking about how RAS fits into this portfolio of solutions that our customers need. We don’t see ourselves as competing with a robotics company or competing with an imaging company. We see ourselves as a partner with our customers in general surgery, and spine procedures, and cranial neurosurgery procedures. And that’s how we develop innovation.
Q: What are the primary barriers to adopting RAS?
A: Cost and infrastructure. But a good way to frame this discussion is to look at where a hospital is on the innovation curve. Technology always has its early adopters who want to be part of shaping the future. As an example, look at Tesla. How many people first bought the Roadster? Not many. But since then, the company has made improvements, and now there’s a platform for broader adoption. Think about that for robotics. We’re in the early adopter phase right now, and there are some who want to partner with us and help shape the future. Those customers are willing to make the financial investment because they feel that ultimately, the investment will be worth it through the procedural improvements they will get. As we continue to make improvements to our technology, we should see a similar trend to the Tesla analogy.
Q: How can Medtronic help extend the potential benefits of RAS to more clinicians and patients today?
A: Medtronic is uniquely positioned in that we are the only one that has an ecosystem of solutions. We’re the only ones who have robotics, navigation, imaging, and powered instruments. And we have the experience. We’ve done more than 4 million navigated cases, 5,000 navigation installs, and 1,500 3D image installs. We have more than 200 RAS installs around the world. The point is, we’re the only partner that has all this technology to integrate. Our competitors are talking about a similar strategy now, too. For them, it’s the future. For us, it’s today’s reality.
Dave Anderson is a certified quality engineer who joined Medtronic in 2018 as the Vice President and General Manager for Enabling Technologies within the Restorative Therapies Group (RTG). In that role, Anderson managed a multi-business portfolio, which included robotics, imaging, powered instruments, advanced energy, and laser-ablation therapy. In 2020, Anderson became the Vice President and President of Neuromodulation.
It is important that patients discuss the potential risks, complications, and benefits of robotic guidance surgery with their doctor prior to receiving treatment, and that they rely on their physician’s judgment. Only a doctor can determine whether a patient is a suitable candidate for this treatment.
Primary risks include infection, device components breaking during use, use by unqualified personnel, and inflammatory reaction to the instruments.
Indications for Use
The Mazor X is indicated for precise positioning of surgical instruments or spinal implants during general spinal surgery. It may be used in open or minimally invasive or percutaneous procedures. Mazor X 3D imaging capabilities provide a processing and conversion of 2D fluoroscopic projections from standard C-Arms into a volumetric 3D image. It is intended to be used whenever the clinician and/or patient benefits from generated 3D imaging of high contrast objects. The Mazor X navigation tracks the position of instruments during spinal surgery in relation to the surgical anatomy and identifies this position on diagnostic or intraoperative images of a patient.
The Mazor X should not be used on patients who have been diagnosed or are suspected of having Creutzfeldt-Jakob disease (CJD). Caution: Federal Law (USA) restricts these devices for sale by or on the order of a physician.