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Robot-assisted surgery serving thousands

princeton — It resembles an assembly line's robot arm or a science fiction movie's prop, but it's one of two robots that local surgeons have used to help perform knee and hip replacement procedures. The WVU Medicine Princeton Community Hospital Orthopedic Center recently announced that over 2,000 robotic-assessed robotic-assisted joint replacements had been performed at its facilities with two Mako robotic systems. Princeton Community Hospital was the first hospital in West Virginia to have two of these robots. During a visit Thursday at one of the two operating rooms using the robotic system, Dr. Philip Branson, MD, medical director of PCH's Orthopedic Center and Dr. Nick Higinbotham, DO, spoke about how the devices changed the way knee and hip procedures are performed now. The Mako system makes incisions more precise, Higinbotham said. Its computer screens allows surgeons to plan operations in three dimensions. 'You're able to see in real time the cuts that you're making, makes minor adjustments and then after all of the implants are in, you're able to actually test the stability of the knee, the alignment, and how it's balanced,' he said. 'We didn't have any of that information prior to having the robot. You kind of had to do it by feel before this technology was available.' The robot does not do the actual surgery. 'Correct,' Higinbotham said. 'It's just an aid. It helps you make more precise cuts and it also gives you realtime feedback. Is the knee balanced and is it in good alignment?' Many patients come from the region's senior citizens, but others have traveled from beyond southern West Virginia and Southwest Virginia. 'We have people coming from as far away as Canada now, so we have people coming from Canada and inquiring about having it (surgery) done here, Branson said. 'In terms of the technology, I think the way it works which differs from the other is called 'Scan, Plan and then the Robot can.' We have three-dimensional scan. The difference between this and previous technology is that we now have a complete three-dimensional model of the entire leg including the hip, the knee and the ankle.' Branson looked at the images on the Mako system's monitors. 'And as you see from the screens, we initially plan the surgery on the robot and establish the alignment. In contrast to the old ways we put rods up into the bones and we approximated what we saw on the X-rays in two dimensions,' Branson said. 'So it's a substantial change. In hip replacement, for example, we can be precise in terms of the length of the leg and what we call the offset of the hip, which decreases the postoperative limp for patients with total hip replacement.' The surgical cutting attachment is connected to three metal spheres on the robot arm's tip. The robot has feedback which positions its arm relative to the bone and tracks the bone's position, Higinbotham said. While the surgeon does the work, the robot helps keep the cuts on track. Higinbotham compared the robot to ones seen on automotive assembly lines. 'The robot positions the cutting device very precisely for us,' Higinbotham said. Branson said most of the over 2,000 surgeries have been performed over the last three years, Princeton Community Hospital ranks seventh out of the 73 hospitals using the Mako device. This area includes larger hospitals such as the Cleveland Clinic and Columbus Hospital which has 40 surgeons. 'For three surgeons, what I think is remarkable first of all is in a community hospital when WVU came in and Karen Bowling (president and CEO of Princeton Community Hospital) came in, they got a second robot, so we use two robots so we can do a higher volume of surgery,' Branson said.' For a community hospital, it is exceptional to have surgeons with a lot of robotic experience, he said. 'We have more people who are traveling in. It's interesting,' Branson said. 'Our primary service is the patients who have been loyal to us for years in the Bluefield, Princeton, Beckley and surrounding areas, but now we have people who are coming in from further distances, so we see more and more of that.' Contact Greg Jordan at gjordan@