Whether a patient is undergoing a minor procedure or complex surgery, Pennsy’s surgeons and specialists are committed to delivering advanced, personalized care. In order to ensure optimal outcomes, these teams consistently develop enhanced surgical techniques, integrate cutting-edge technologies into their practice, and embrace ever-evolving tools to improve efficacy and accuracy.
Here are three recent innovative firsts led by the hospital’s neurosurgery and orthopaedic surgery teams:
A Spine Tech Trial Run
Last month, the Penn Spine Center at PAH welcomed two new innovative products supplied by Brainlab: a spinal navigation system and a robotic arm. For neurosurgeon Jang W. Yoon, MD, MSc, the opportunity to test these technologies while performing a minimally invasive lumbar spine surgery was very exciting.
The navigation system acted as a sort of GPS for spine surgeries, allowing Yoon to visualize his trajectory via real-time 3D CT scans, rather than relying on X-rays. Because it is challenging to position a screw while a patient is lying in a lateral position, this surgery would normally a two-stage operation while a patient was on their side, then on their stomach. However, the flexible robotic arm seamlessly lined up with the navigation system’s coordinates, allowing Yoon to accurately place the screw without changing the patient’s position.
“While the jury is still out on whether these technologies can shorten hospitalizations or recovery times, when used in the right settings, they can improve the surgical workflow, cut down on OR time, and reduce X-ray radiation exposure. That all leads to safer, more efficient procedures,” Yoon said. “We’re always bringing in new technology to better care for patients, and I think in the next ten years we’ll consistently have robots assisting in our surgeries.”
Creating Nearly Natural Knees
When a patient with debilitating knee pain undergoes a traditional total knee replacement (knee arthroplasty), their surgeon often removes one or two ligaments, depending on the ligaments’ condition. However, Neil P. Sheth, MD, chief of Orthopaedic Surgery, is one of a handful of surgeons in the nation who opts to preserve all four ligaments whenever possible to help his patients’ new knees feel natural and move normally. In July, Sheth gained access to advanced technology with the power to provide even more precision: a NAVIO navigation system.
This robot helps orthopaedic surgeons plan their trajectory pre-operatively and supports more accurate implantation. “When we think about adopting new technology, it’s not about getting a new toy; we need to think about what problem we’re trying to solve, and how it can help our patients,” Sheth said. “The robot isn’t going to inherently improve outcomes in every type of procedure, but if one patient’s knee needs 3.7 degrees of slope and the next patient needs 5.1 degrees of slope, the robot can dial in those differences more accurately that I could on my own.”
Combined with Sheth’s experience in saving all four ligaments, the navigation system allows for reconstruction based on each patient’s unique anatomy, offering a robot-assisted, personalized procedure that is not available elsewhere in the region.
A Revolutionary Approach to Hip Revision
Hip replacements are one of the most common joint replacement operations, but sometimes fixation does not go as planned due to bone loss or other issues, and revision surgery is required. This summer, Sheth operated on a patient who received their implant at another hospital, then the entire construct failed within a few days. He quickly recognized that the problem could be solved by placing a long screw in the patient's pelvis, though this approach is very technically complex.
“You’re trying to put a screw in a narrow corridor that’s maybe seven millimeters wide, and the biggest blood vessels are two millimeters away. But if you’re going to do these types of cases, you’ve got to take the risk and put screws where you need them,” Sheth said. “The right screw in the right spot will prevent patterns of failure and improve the longevity of the implant.”
Reflecting on comments from colleagues who have expressed interest in watching him perform this challenging procedure, he set up a cadaver lab to determine what types of intraoperative X-rays are most successful in helping surgeons determine whether this screw placement is safe for their patient. Sheth and the Orthopaedic Surgery residents he has trained in this approach are now working on a paper describing this game-changing technique.a