ROBOT AGE ARRIVES FOR BOULDER-AREA OPERATING ROOMS
March of the robots fully arrives at Boulder-area operating rooms
You’ll let robots prepare your burgers, check you in to your hotel, build your cars, mix your drinks and even fight your wars. So how about to operate on your spine?
The idea might not sit well at first blush with some, but roboticassisted surgery, far from being an artifact of some dystopian nearfuture science fiction, has gone solidly mainstream and increasingly represents the state-of-theart medical technology for a wide range of surgical procedures ranging from full joint replacements to spinal fusion.
The Boulder County area now offers a variety of procedures involving robotic technology, both at area hospitals, and also free-standing ambulatory surgical practices that send patients home the same day from procedures such as hip replacements, which once would have required lengthy hospital stays.
Boulder resident Bruce Borowsky, 59, has suffered knee issues for some time, having had both knees surgically repaired for meniscus tears over the years. But still, his left knee had for some time still been in a bad way.
“I’m very active. I travel all over the world constantly, and I’ve been able to power through the pain, and I’m able to forget about it pretty well for the most part. But sometimes it catches up to me, after a day spent hiking or filming or whatever,” said Borowsky, a producer at Pixel Mill Studios, and co-founder of Boulder Digital Arts.
He saw joint replacement surgeon Dr. Brian Blackwood speak at the Boulder Jewish Community Center two years ago, and subsequently made an appointment.
“He told Jenny (his wife, Jenny Doyle) and I that he could do the surgery right then, that I was wellqualified,” Borowsky said. “But he also said in his experience it’s generally best to wait as long as you can. Because generally, you only want to do this once.”
That day finally came on Feb. 19, at Boulder Community Health. Borowsky said he did not overeducate himself on what the procedure would entail.
“The less I know, the better,” Borowsky said two days prior to the procedure. “Jenny understands it. She’s a health care professional. But for me, I guess the best way to describe it is my reaction to one of the nurses at the doctor’s office, who said, ‘It’s sort of like a carpentry workshop, in there.’ The less I know, the better.”
Doyle said, when the procedure was done that day, “I’ve seen oil changes that took longer.” Her husband went home from BCH by noon the next day.
“Mild trepidation” is gone
Just more than three weeks earlier, Blackwood, a surgeon at the Boulder Centre for Orthopedics and Spine, performed Colorado’s first Mako robotic-assisted joint replacement in an ambulatory surgery setting in Colorado.
He did so at the Boulder Surgery Center, which is partnered with BCH, and according to Stryker, its manufacturer, is currently the only surgery center offering the Mako robotic-assisted joint replacements in Colorado.
“Since I came here seven years ago, we’ve more than doubled the joint volume at the hospital with the robotics, and then we have shortened the length of stay by 60% or 70%,” Blackwood said. He received his fellowship training at the Coon Joint Replacement Institute north of San Francisco, came to Boulder in 2016, and is now a veteran of more than 2,000 joint replacement procedures.
BCH was the second hospital in the state to offer Mako roboticassisted total hip replacement and partial knee replacement, and the first to offer Mako total knee replacement, having completed more than 2,050 joint replacements since 2013, according to marketing manager Celanie Pinnell.
“Robotic-arm assistance allows me to perform the surgery with less-invasive techniques,” Blackwood said. “It also aids in both perfect implant placement and soft-tissue balancing, leading to increased patient satisfaction, better function and improved longevity of the results.”
At a recent exhibit of robotic technologies held by BCH at the Boulder Jewish Community Center dubbed “Robopalooza,” Blackwood demonstrated aspects of the medical craft for visitors who included potential donors to the Boulder Community Health Foundation.
“We were one of the first places in the country, and the world, to really do the total knee replacement application” robotically, Blackwood said. “Before, it was partial knees, from to 2006 to 2011. And in 2011 they added total hip, and in 2016 they added the total knee.”
The era of people shying away from robotic intrusion into the body, he said, is well past.
“For initial patients, there was a little bit of mild trepidation. That rapidly went away,” Blackwood said. “People assume every single surgery I do now is done with the robot, and people actually search it out and want to have that technology involved in their case and procedure.”
Explaining how the robot can see where the saw is during surgery, he said Accustop technology that is part of the system will not allow him to activate a bone saw when the blade is not properly located.
“You can still screw up if you try hard enough, but it helps prevent it,” Blackwood said. “We can see where we’re actually going to make the cuts on the bone and follow that in real time, and stay out of the soft tissue.”
The benefits from robotic-assisted surgery, he said, are numerous.
“There are studies showing there is less soft tissue damage and more accurate cuts with using the robotic arm system than using the manual traditional techniques,” Blackwood said. “In addition, there are studies showing there is less use of opioids after the surgery, shorter hospital stays, faster recovery and less use of physical therapy.”
A recent executive order by Gov. Jared Polis has suspended all “nonessential” surgeries and medical procedures in Colorado in order to free up equipment, including ventilators and personal protection items for staff battling the coronavirus.
“Essentially, carpentry”
While Mako technology is well established in local operating rooms, the newest addition to the menu of what’s available in robotic-assisted surgery is Mazor X Stealth spine surgery, typically deployed in spinal fusion procedures.
The Mazor X Stealth system combines proprietary software to plan the surgical procedures, a robotic arm to precisely guide the placement of implants during complicated spine surgery, and real-time navigation feedback to make sure the procedure goes as planned. BCH’S Foothills Hospital was the first Colorado hospital north of Denver to offer it, having acquired it Feb. 4.
Dr. Kara Beasley is a neurosurgeon at Boulder Neurological & Spine Associates, and was scheduled to perform her first spinal fusion with it earlier this month. As of mid-march, the BCH Foothills Hospital had completed seven, but anticipated that number would grow as more people seek it out.
She was singing its praises and offering demonstrations at the JCC event. The Mazor X Stealth system was only launched in the U.S. in January of last year.
“What the robot lets us do is be more accurate than we can be” without it, Beasley said. “I’m only a human. My partners are only human, so we make surgical judgments, and even just moving our hand a couple of degrees in a certain direction can change the entire trajectory of a screw as it’s going in. And that can cause problems.
“What the robot does is it prevents us from having that human error or that human deviation as we’re putting screws and rods in. So it makes us far more accurate.”
Beasley, who joked that what she does is “essentially carpentry” — the vocabulary of her trade includes screwdrivers, taps and drills — emphasized that decompression of the spine during surgery, the removal or bone or discs, is still done “with my own two hands.” In three to five years, she expects that to also be accomplished with the help of robotics.
“What this allows me to do is to be faster, safer, and a quicker placement of the screws. The surgeon is still running it. It’s not like I press a button and walk out of the room,” Beasley said.
“Complete faith”
Borowsky, two weeks after his surgery, was still contending with some pain but was well along in his recovery.
“I’m walking without a cane or walker,” said Borowsky, who had driven his car for the first time post-surgery the day before. In fact, he said, “They had me walking up and down stairs the same day as my surgery.”
He had his first session of physical therapy nine days after the knee replacement, with two more on tap the week that followed.
An avid tennis player as well as a fan of other outdoor pursuits, Borowsky didn’t yet know his timeline for a return to all the activities he loves.
“They’ve made no promises and I have very low expectations. I made sure I didn’t have anything planned, so I wouldn’t feel rushed. I’m just kind of going with the flow and I look forward to playing tennis again, as quickly as possible,” he said.
“I look forward to that day when I wake up and there’s no pain. But I have complete faith in the doctors, and the surgery.”