Life Sciences Success Story

The pursuit of perfection: robots in the OR

Innovation is built on history

The history of surgical instruments goes back a very long way. Hippocrates is regarded as the father of classical surgery. By around 500 BC, there were already more than 200 different instruments used in surgical procedures. In the centuries that followed, the development of instruments was influenced by the healing
methods of individual doctors. Medical practitioners drew up specifications,
which skillful craftsmen used to create ornate instruments. A new level was reached in the 19th and 20th centuries as precious elements such as ivory, gold and silver were set aside, and precision mechanics and cutlers began making instruments
from steel. In 1939, the profession of surgical mechanic was born.

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A milestone in modern surgery - robotic surgical assistants.
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The modular ROSA® system.

ROSA® technology is an FDA-approved, next-generation surgical robot in use at more than 200 hospitals. Developed by surgeons for surgeons, Zimmer Biomet’s robotics technology, complete with an integrated navigation platform, has assisted in numerous surgeries around.

In many cases, non-robotic surgery is still needed, depending on the procedure. This method involves making large incisions in the area to be operated on. Doing so provides the surgeon with a large field of vision, and allows direct access for the entry and manipulation of surgical instruments. With modern minimally invasive techniques, however, the incisions are no larger than needed to insert the surgical instruments. As a result, extensive areas of skin no longer have to be peeled back before the procedure proper can commence. The limited field of vision is compensated for by the use of imaging technology.

The ROSA® technology system consists of two mobile units that are placed adjacent to the operating table. One is used for the Spine and Brain Application, and another for the Spine Application only. The ROSA® One Spine Application has dynamic tracking. One of the two units has a camera to continuously monitor the motion of the other unit in three dimensions. A Stäubli six-axis robot is mounted on a rigid frame. The robot arm, holding the instrument, carries out its movements in parallel with those shown on the monitor. A distinctive feature of the ROSA ONE® Spine Application is that it recognizes and takes into account the slightest shift of position, for example of the thorax during breathing. This dynamic tracking is designed for constant adjustment of the parameters, allowing for the precision of the instrument trajectory and minimizing procedural risks.

Combining innovative robotics with surgery, ROSA® technology can also incorporate advanced implants made from innovative materials. Combining advanced imaging methodologies is another reason for robotics in the OR. ROSA® Knee system imaging modalities, combined with intraoperative data, allows surgeons to conduct a “virtual knee replacement” with predictive outcomes of balance and implant placement before performing any cuts. Flexible imaging modalities, including X-ray based imaging and imageless options, give surgeons and patients lower imaging costs as well as convenience in preparing for surgeries. Preoperative planning with Zimmer Biomet 2D X-ray to 3D bone modeling technology limits instrumentation in the OR and facilitates custom plans based on the patient’s unique anatomy.

Six degrees of freedom and meticulous monitoring In terms of mechanics, ROSA® consists of a robotic arm with six degrees of freedom. Similar to the human arm, it can perform exact multidimensional movements. This makes it a high-precision aid for surgeons who require maximum freedom of movement in every imaginable plane in order to carry out procedures to the highest standards. The mechanical components are complemented by assisted navigation. This unit allows surgeons to visualize their instruments in real time on patient images. The robot’s haptic capabilities allow surgeons to manually and precisely guide and manipulate their instruments within the limits set in the planning phase. In this human-machine interaction, surgeons can continue to apply their individual skills while the system learns from them.