The Center of Excellence in Orthopedics at Premiere Hospital has one of the most efficient surgical robots specializing in orthopedic surgery since December 2023. The ROSA Knee system already works as a real assistant in the operating room and provides advice to the surgeon in real time and precision in the practical surgical operation.

What is ROSA Knee, what does it do and what advantages does the technology give to the patient and the doctor, explained prof. University Dr. Radu Preibeanu, Orthopedic Surgeon and Traumatologist, Coordinator of the Center of Excellence in Orthopedic Surgery and Medical Director of Premiere Hospital, Timisoara.

The ROSA Knee system’s technical book states that it is “designed and built by surgeons for surgeons”. What is the ROSA robot and what does it do?

Dr. Radu Preibeanu: ROSA Knee is a surgical robot, i.e. a tool that ensures precision, predictability, improves the results of the surgical procedure and offers the patient the best possible result from a functional point of view, as well as a faster and easier recovery. . The most important thing is that it brings in real time, during the surgical action, a very precise feedback about the result that the surgical gesture will have, before it actually happens. Thus, the doctor can confirm or change his decision.

It is a completely new way of surgery that eliminates errors and offers great benefits in patient recovery. When the surgeon makes an incision, resection of the bone – because we are talking about knee replacement, it is final. In addition, interventions on the knee joint are also the most difficult, the joint has such a character. We cannot bring back what we cut out. Surgical maneuvers involve adjustments on the order of millimeters, and there is a big difference in the end result between a 2-millimeter resection and a 4-millimeter resection, for example.

This is where the ROSA Knee robot comes to the rescue, which very accurately shows the surgeon that he gets 2 or 4 millimeters after the bone resection, so the doctor will make the optimal decision. In other words, ROSA Knee very precisely advises the doctor during the actual operation before making the surgical gesture.

And there is another aspect that should be taken into account. Knee arthroplasty is performed on an already deformed joint. The goal of prosthetics is to return the knee joint to the state it was in before the disease. ROSA Knee sees and understands this healthy state of the knee and correlates it when it “collaborates” with the doctor, so that surgical maneuvers fully restore the anatomy and function of the joint after the prosthesis is implanted.

Naturally, the question arises as to how ROSA Knee knows to provide all this information and what are the guarantees that the information provided to the doctor is correct.

Dr. Radu Preibeanu: Every patient is unique. Accordingly, the surgical approach will be individual for each patient. This is the starting point, the uniqueness of the patient.

There is a preoperative plan with the involvement of all biometric data of the limb and joint that is subject to surgical treatment. These are X-ray and CT images. The robot and case-by-case data customize the surgical plan to the patient’s unique needs.

All this data is used by ROSA Knee. Based on this highly accurate, comprehensive information, the robot shows the doctor what the outcome will be based on what he is going to do during the surgery. The robot doesn’t give you the solution, the doctor chooses the solution, but it shows you the consequences. The artificial intelligence program also has the ability to accumulate information, and this contributes to the improvement of the system, every case in which the robot participates is a lesson for it from a certain point of view. And the benefit is again for the patient and the doctor.

What other possibilities does the ROSA Knee system offer?

Dr. Radu Preibeanu: The robot arm supports the surgical act with the help of templates. If the resection of the bone, the incisions on the ligaments that the doctor must make in the operating field for endoprosthetics have been evaluated and set exactly as I explained before, knowing exactly what the effect of these maneuvers is, and you must cut, for example, 3 millimeters, the robotic arm templates will help me cut with absolute precision exactly 3 millimeters.

The ROSA Knee support allows you to adjust the intervention in such a way that any aggression that is not necessary for the soft tissues is minimized. This is not a minimally invasive intervention, as this concept has entered the generally accepted lexicon, but the operative trauma is significantly reduced, one might even say, to a minimum, and this is reflected in a faster postoperative recovery, much less painful for the patient.

ROSA is not the only robotic surgeon involved in orthopedic operations. The Mako robot also works in the Regina Maria network. Are there differences between the two systems?

Dr. Radu Preibeanu:These are different technologies, but equally effective. One cannot say that one is better than the other. Both work by uploading patient data. At ROSA Knee, I, the doctor, use the tools. The robot’s templates help me cut precisely, and I, the surgeon, decide what to do by choosing the best option from those predicted by the robot.Mako Total Hip and Mako Total Knee only work with planned loading and preoperative imaging. Validation is carried out by a specialized engineer and a doctor. A predetermined plan is applied intraoperatively.

How many assisted ROSA Knee interventions have you performed between December and now (no – February 15, 2024)? How did they go?

Dr. Radu Preibeanu:I have already performed a significant number of knee replacement procedures with the ROSA Knee. This is after more than 3,000 such procedures performed in the classic way. Classic is calculations, evaluations, checks, so that after classic surgery, the knee returns to its normal shape, the one it had before the appearance of pathology that requires prosthetics.

However, interventions performed with ROSA Knee were exceptionally safe, less traumatic for the patient, faster and with very good results. Personally, I am very happy to work with this robotic system. The checks that are part of the routine of classical surgery were no longer needed, and that’s because I knew exactly what the effect and end result of every surgical gesture I made was before I made it.

I have to admit, I like working with the ROSA Knee system. On the one hand, since this is the way I used to validate my surgical decisions, and a little extra validation never hurt anyone, on the other hand, I can admit that I had to learn from a robot. His precision, sophistication, his ability to synthesize and analyze information, and his speed are admirable.

I also want to say that there is no surgical intervention that would guarantee the absence of complications, but the use of a robot makes it possible to reduce them to a minimum, which cannot be achieved in classical surgery.

How important is a doctor’s previous experience?

Dr. Radu Preibeanu: This is important and fundamental. The simple fact that the surgeon during the intervention chooses a decision based on the expectations that the robot makes requires experience. A doctor, not a robot, operates. I use the ROSA Knee scores, but the decisions and surgical gesture are my own.

What are the arguments in favor of a patient choosing a robotic solution for knee surgery?

Dr. Radu Preibeanu: I have already talked a lot about its advantages. What better argument than that there is no more risk of error? The robot shows the effect of a surgical gesture. It doesn’t give you solutions, but it helps you in a proportion that strives for 100% so that you don’t make a mistake.

Surgical work is a huge benefit for the patient, from the precision of the intervention to the quick recovery. It’s possible to navigate your way using a map or previous information you have, but it’s much safer to use a GPS that tells you everything you need to know. You’re driving in both situations, but the information you have is fundamentally different in one case than in the other. And this leads to safety on the road. The same is true in surgery, when robots are used, regardless of their type.

By Silvana Patrascanu, Senior Medical Editor

Consulted:university prof. Dr. Radu Preibeanu, Orthopedic and Traumatologist, Coordinator of the Center of Excellence in Orthopedic Surgery and Medical Director of Premiere Hospital, Timisoara.

The article was approved by Queen Mary