New generations of spine robots in the market have significant advantages compared to their predecessors, Suken Shah, MD, said.
Dr. Shah, of Wilmington, Del.-based Nemours Children’s Hospital, spoke with Becker’s about the unique challenges in pediatric spine surgery and how a new Velys robot is addressing those.
Note: This conversation was edited for clarity and length.
Question: Are there any gaps in spine robot innovation when it comes to working with children versus adults?
Dr. Suken Shah: We always say that children are not just small adults. They have different physiology, and we have to deal with growth during the phase that they actually have a spinal deformity. Typically that spinal deformity can progress during growth in surgery, and not only are the bones smaller, but with deformity, the spine is very rotated. The trajectories are not standard, and the fusions are very long. With an adult degenerative spine patient, you’re doing a one or two level fusion. Typically, in our practice, we’re doing 12, 13 or 14, level fusions.
One of the gaps in navigation and robotic technology is that the registration is very accurate and close to the reference array. But as you start to move away from that reference array, it could become less and less accurate, which could be critical in improper screw placement or trajectory. We have to be conscientious of that and continue to verify that the robot is seeing what we’re seeing in real life. Our experience in doing this surgery freehand makes us that much better using the robot, because we can verify in real time that the robot continues to be accurate with regard to the reference array.
The other gap is that if the patient moves even slightly, then the reference array can become inaccurate. The Velys robot is unique because it has this active assist technology that can follow small movements of the patient with regard to respiration. The patient is on a ventilator and their chest is moving up and down. That includes small spine movements. This robot can incorporate those small movements in real time, and you actually see the arm moving very slightly with the patient. If the patient was to be changed in their position on the table, then the robot will follow. So this active assist technology feature is one of the key reasons we went with this robot over the others.
Q: Are there any other advantages you’re seeing with the Velys robot compared to past generations of spine robots?
SS: Previous generations of robots were so rigid because even small millimeter movements can produce inaccuracies. It was almost too rigid to the point where when you put the screw all the way to the bone, it was actually hard to get the screwdriver off because the robot was so rigid and everything would be held down. The Velys robot senses that at 80% length of screw insertion, it becomes passive. You can actually see the robot relax its grip on the screwdriver, and it’s very easy to disengage the screwdriver from the screw and make the workflow that much more efficient.
If you want to toggle between using the robot, doing freehand or using the navigation that the robot is paired with, you can press a button and gently push the robot arm away. That tumbling back and forth is another feature that the previous robots really didn’t have. There’s also been very low adoption in pediatrics. Lots of centers have added robots in the adult space. But with deformity between children, they’re just added challenges to robotic technology. We’re really excited that we’re one of the first centers to use this technology in children.
