Neurosurgeons at Weill Cornell Medicine and Och Spine at NewYork-Presbyterian performed the East Coast's first robotic spine tumor surgeries using a fundamentally new category of surgical robot, including the world's first use of the technology on a cervical spine tumor and metastatic spinal tumor.
Roger Härtl, MD, Hansen-MacDonald Professor of Neurological Surgery, Director of Neurosurgery Spine at Weill Cornell Medicine and Co-Director of Och Spine at NewYork-Presbyterian, along with Ibrahim Hussain, MD, Assistant Professor of Neurological Surgery and Leonard and Fleur Harlan Clinical Scholar and Justiss Kallos, MD, Assistant Professor of Neurological Surgery, completed three spine tumor cases (cervical, thoracic and lumbar) using the Symani Surgical System.
Not Your Usual Spine Robot
Robots are not new to spine surgery, but until now, they have served a very different purpose.
"The robots that are being used in spine surgery are robots that help surgeons put screws into the spine," Dr. Härtl explains. "It's basically a device that holds a trajectory. It doesn't move."
Those are "hard-tissue" robots, designed to guide instruments precisely into bone. This new device is something else entirely: a soft-tissue robot, conceptually similar to the da Vinci system that has been used for abdominal procedures for more than a decade, but engineered at a scale small enough for the spine.
Working from a console a few feet from the operating table, the surgeon manipulates miniature wristed instruments that translate hand movements into micro-scale motion. The robot incorporates tremor filtering and motion scaling that allow a level of precision beyond what the human hand alone can achieve.
A Glimpse Into the Future
For a surgeon with decades in the OR, the experience itself was striking.
"Everything we do has always been right there: we're sterile, we're scrubbed in, we're right at the patient," Dr. Härtl says. "It was very unusual and unique to be sitting a few yards away, controlling everything with micro-movements, doing very precise and elaborate surgery without really being next to the patient. That was certainly pretty amazing. It gives you a glimpse of what's going to come in the future."
What Comes Next
Dr. Härtl - who performed the world’s first robotic resection of a cervical spine tumor sees a much broader horizon than just using these types of robots for spinal tumor cases. His team is working to refine the technology for minimally invasive spine surgery, combining the robot with 3D navigation and augmented reality.
"It's very promising technology, and we want to refine it to make it more user-friendly for minimally invasive surgery," he says.
Dr. Hussain performed the world’s first robotic resection of a lumbar metastatic spinal tumor using the Symani system. “This is a major step forward in robotic technologic innovation in spine surgery. We are now working on applications for more delicate surgeries using this robotic system in cadavers and simulation models, including spinal cord and nerve sheath tumors, spinal cysts, and spinal fluid leak repair” .
The technology will be featured at the NYC Minimally Invasive Spine Surgery (NYCMISS) innovation symposium this December, hosted in partnership with the Seattle Science Foundation. The annual meeting highlights emerging technology like robotics, augmented and virtual reality, endoscopy, new implants and biologics with a critical eye.
"The goal of our December meeting is always to highlight new and exciting technology that will allow us to do surgery safer, more effectively, more precisely," Dr. Härtl says. "We give surgeons a platform to talk about what they're passionate about, but also to have debates. It's a chance to weigh the pros and cons of these technologies."
For now, the three cases stand as a milestone for the department and for a field on the edge of a new era.
To learn more about innovations in spine care at Weill Cornell Medicine, visit https://weillcornell.org/spine-surgery.