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Once questioned as science fiction, more surgeons becoming open to using robots

Surgeons are increasingly becoming more open to using robots during medical procedures, which is good news for medical device manufacturers including Stryker Corp. and Smith & Nephew PLC.

Just a few years ago, using robots in surgeries was “barely on the map,” said Patrick Meere, an early adopter of the technology that helps guide surgeons during procedures. But over the last few months, there have been signs that what was once considered science fiction is increasingly being accepted by knee and hip surgeons.

At the American Academy of Orthopedic Surgeons conference on March 7, a small majority of attendees voted for him over a robotics skeptic following a debate on robot-assisted surgery. Meere saw his narrow victory as a sign that while not all surgeons might be ready to use the robots, they are willing to consider it.

Though the use of robots remains controversial among surgeons, who cite concerns about costs and a need for more data, “it’s no longer an issue whether robots are going to die or go away,” Meere, the co-director of the orthopedic robotic surgery program at NYU Langone Health, said in an interview.

He pointed to a November 2017 study published in the Journal of Arthroplasty that found 17.1% of New York state surgeons reported using robots in 2015, up from 6.2% in 2008.

The percentage of New York hospitals using such robots also rose to 29.2% from 16.2%, according to the study by researchers at NYU Langone Health and Mount Sinai Medical Center in New York.

That is still a minority. For Matthew Boylan, an NYU Langone Health orthopedic surgery resident and lead author of the study, two issues need to be addressed: a roughly $500,000 price tag at a time when federal policies are focused on trying to reduce spending and a lack of studies examining whether patients are doing better long after robot-assisted procedures.

Even proponents like Meere, the co-director of the orthopedic robotic surgery program at NYU Langone Health, agree with skeptics that more research is needed on the long-term effects of robotic-assisted surgeries before a large majority of hip and knee implants are performed with the technology.

But attitudes about using the robots seem to have shifted at the orthopedic surgeons’ conference from the year before, from “‘do I need a robot’ to ‘which one is best for me?'” wrote Joanne Wuensch, managing director of BMO Capital Markets, in a March 8 note to investors.

Meanwhile, Stryker, which introduced a robotic total-knee replacement system last year on top of existing ones for partial-knee and hip replacements, expected installations to double in 2018, company Vice President for Strategy and Investor Relations Katherine Owen said on a Jan. 30 earnings call.

That would come after their systems were used in twice as many procedures in 2017 than the previous year, she said.

Driving the increase in use, Meere said, is the reassurance robots give as a “co-pilot” during surgeries. The robots are an improvement over navigation systems that gave surgeons a blueprint of where to cut.A Stryker spokeswoman declined to comment on the price of the company’s system. Stryker Vice President and Chief Technology Officer Robert Cohen said in an interview that he did not think price would deter hospitals from buying the robots. If their surgeons feel they are necessary, hospitals would find a way to buy them like any other medical equipment, even if it means taking out loans, he said.

The new systems provide 3-D imaging to help determine the size and placement of implants, he said. During surgeries, some robots will make cuts on instruments mounted to its arms, while others guide surgeons in doing the cutting, like jigs.

“It makes a huge difference. The level of stress is a lot less,” Meere said. “It eliminates questions like what if my hand were to slip.”

At least in the short term, a Baker Tilly study commissioned by Stryker found increased precision offered by robots can reduce readmission costs for hospitals by two-thirds after 90 days, compared to human-only surgeries.

Stryker “has an early lead but it’s not a foregone conclusion they can maintain this,” Mike Matson, Needham & Co.’s senior research analyst for medical technologies and diagnostics.

Johnson & Johnson in February purchased Orthotaxy, which is in the early stages of developing a partial and full-knee replacement robot. Zimmer Biomet Holdings Inc. is on schedule to begin clinical evaluations for its Rose knee robotic system in the second half of this year, Matson wrote.

In addition to Stryker and Smith & Nephew PLC, the U.K. maker of the NAVIO surgical robot, four manufacturers should have “some sort of robotics solution within a few years,” Matson wrote.

Robotics “is here to stay,” he wrote in an email. But it is too early to tell if it will someday be used in all procedures.

Stryker’s Cohen is more optimistic. “As more surgeons call for having robots, it will become the standard of care. And you will have more surgeons talking about surgical data on podiums around the world,” he said in an interview.

The company has sold the Mako Systems to the Cleveland Clinic and other teaching institutions. “When all those residents start graduating, everything is tipped in our favor,” Cohen said.

“The increase in utilization has been quite significant,” Boylan said in an interview. “Whether or not that continues to grow or plateaus and eventually dies down, I don’t know.”

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