ROBODOC is a surgical robot that performs total hip and total knee replacement surgeries. In 1992, it was the first robot in the United States to operate on a human patient. Since then, it has performed over 28,000 orthopedic procedures worldwide. Unlike other surgical robots, which are controlled by the surgeon in real-time and take on a more passive role, the ROBODOC is pre-programmed before the operation giving it more autonomy during the procedure. The technology behind this device is the result of collaboration between physicians, medical researchers, engineers, and graduate students.
This 1989 ROBODOC prototype is a modified industrial robot that has been adapted for medical applications. Its development was helped by Howard “Hap” Paul, a doctor of veterinary medicine, and Dr. William Bargar, an orthopedic surgeon. The two met at the University of California, Davis Medical School.
Research and development for the surgical robot began in 1986 when IBM's Thomas J. Watson Research Center, and researchers at the University of California, Davis began a collaborative initiative of an innovative system for Total Hip Arthroplasty (THA). Their goal was to create a robotic surgical system that would redefine precision joint replacement surgery.
By 1990, the system was first used to perform a total hip replacement on a dog with a congenital hip problem. Dr. Paul developed a canine clinical study in which fifteen dogs were treated manually and another twenty-five were treated with robotic assistance. The study was a success and very promising for the burgeoning field of medical robotics.
On November 7, 1992, a surgical team lead by Dr. Bargar at Sutter General Hospital, Sacramento, California, used Robodoc to perform the first robot-assisted human hip replacement. The operation was the first of ten at the hospital approved by the federal Food and Drug Administration (FDA) to determine the safety and feasibility of the device. The success cleared the way for nationwide clinical trials which began in 1993.
Traditionally in orthopedic procedures, the surgeon manually drills a cavity into the femoral shaft for the implant. This method leaves some space between the bone and implant; the fit is imperfect and sometimes bone cement is used to fill in the gaps. Depending on the age and activity level of the patient, as well as the type of implant received, total hip replacements can have a ten-to-twenty-five-year life on average. The breakdown of the cement from everyday wear may require a revision surgery, which carries further complications such as cleaning out the cement from the cavity. The precision of the ROBODOC allows for cementless implantation which is a better option for young patients who may lead more physically active lives and require an implant to last long-term.
The precise fit is made possible due to the computerized, three-dimensional preoperative planning system. Surgeons previously worked with two-dimensional X-ray to plan the operation and select the implant. ORTHODOC, the preoperative workstation, takes information from the computerized tomography (CT) scan to create a three-dimensional model of the patient’s bone. This allows the surgeon to select an implant and precisely position it within the planned cavity. This data is stored on a tape cartridge, which is inserted into the robot’s computer on the day of the procedure. Laboratory testing showed that the ROBODOC creates cavities in which 95% of the implant is within 1 mm of bone. In contrast, manual techniques yield cavities in which only 20-30% of the implant is within 1 mm of bone. This greater precision encourages bone ingrowth, stability, and reduces the likelihood that revision surgery will be required. It is believed that the benefits of this robot extend beyond the patient. The surgeon is able to practice with better outcomes, and the hospital saves resources as a result of shorter patient stays, shorter operation time, fewer intraoperative complications, and faster recovery times.
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