Robotic Surgery

The Navio system, developed by Smith & Nephew, is a handheld robotic-assisted platform used in knee replacement surgeries. Unlike other systems that rely on preoperative CT scans, Navio uses real-time imaging and mapping to create a customized surgical plan. This eliminates exposure to preoperative radiation while ensuring precise bone cuts and implant alignment.

Dr Alan Cheung underwent his training in the Navio system (Smith and Nephew) at the Scripps Mercy Hospital in San Diego, California USA.

The Navio system uses a robotic handheld burr to assist with partial and total knee replacements. The difference with this system is that there is no preoperative CT scan. Instead, the surgeon registers a number of points on the bone of the joint surface to be operated on, creating an intraoperative 3D map of the knee joint. This enables “real time imaging” during the surgery.

The Navio handpiece is used to burr away the desired bone according to a patient-specific plan. Although the Navio equipment is smaller and more portable than a MAKOplasty machine, it does not provide haptic (tactile) feedback, and it is vital that the surgeon accurately registers the intraoperative points, as there is no CT-based 3D virtual model.

Early results from the Navio system are promising. A study in France looked at unicompartmental knee replacements (UKR) performed in 80 patients using the Navio system. These patients were matched with 80 patients undergoing UKR using the same prosthesis, implanted using a non-robotic technique.

At around two years, the patients with Navio assisted surgery had better limb alignment and a lower revision rate. The accuracy of implant positioning is improved by the Navio robotic-assisted system.

ROBODOC, developed by Curexo Technology, was one of the first robotic-assisted surgical systems introduced in orthopaedics. It is primarily used for total hip and knee replacements, offering unparalleled precision in bone preparation. By eliminating manual inconsistencies, ROBODOC enhances the accuracy of implant fit, reducing postoperative complications and ensuring better long-term results.

Dr Alan Cheung underwent his training in the ROBODOC system at the Mirae Hospital in Busan, South Korea.

It relies on a preoperative CT scan of the limb to create a 3D plan, which the surgeon then uses to map regions of the joint during surgery. The difference between ROBODOC and the other systems is that the robot is fully autonomous (i.e. self guided).

Once Dr Cheung has guided the robot cutter arm to the bone surface, the ROBODOC machine will automatically mill away the bone without any guidance. Dr Cheung is in control at all times and can stop the procedure at any point if required. He then manually implants the joint replacement as per usual.

There is evidence to suggest that the Robodoc system has some advantages in performing total knee replacement and total hip replacement.

No, robotic surgery is surgeon-controlled. The robot enhances precision, but the surgeon makes all critical decisions and performs the procedure under robotic guidance.

Robotic joint replacement surgeries typically take about the same time as conventional procedures, usually between 1 to 2 hours, but may be slightly longer in complex cases.

Yes, robotic surgery is considered safe. It minimizes human errors, enhances accuracy, and reduces complications, but, like any procedure, it carries inherent surgical risks.

Yes, due to smaller incisions, reduced tissue trauma, and precise implant placement, many patients experience quicker recovery and return to normal activities faster.

Not necessarily. While robotic surgery benefits many patients, factors like bone quality, pre-existing conditions, and patient anatomy determine suitability.

Coverage varies depending on the healthcare provider and policy. It’s advisable to check with your insurance company regarding robotic-assisted surgical procedures.