Michael Barbella, Managing Editor11.16.22
The magnitude of the discovery was lost at first.
To its excavators, the finding resembled a surgical robotic arm, but it looked markedly different than any they’d ever seen. Simple in structure, the arm lacked the sophistication and sleek, compact design of current models; clearly, the recovered arm was part of an older (outdated) robotic surgical system.
And not just any older system—the very first one, actually.
The excavators—i.e., THINK Surgical Inc. workers—inadvertently stumbled upon the robotic remnants while cleaning out a company-owned storage facility in the San Francisco Bay area. The arm belonged to ROBODOC, a robotic surgical system that made its global debut 30 years ago at Sutter General Hospital (now Medical Center) in Sacramento, Calif.
Standing seven feet tall, ROBODOC’s articulated arm had a drill attached to the end that enabled surgeons to more accurately place artificial joints and implants. ROBODOC was the first innovation to wed robotics and medical imaging, using computed tomography (CT) scans converted into 3D virtual images for pre-operative planning and computer-guided drilling.
Like most revolutionary inventions, ROBODOC was conceived in a moment of frustration. Total hip arthroplasty (THA) was substandard and maddeningly unpredictable in the 1980s due to inferior materials (specifically, acrylic cement) and the lack of technology. Back then, surgeons typically chiseled out an imperfectly-sized cavity in the bone to fit an implant that was manufactured in only a few sizes.
University of California-Davis staff members William Bargar, M.D., and the late veterinarian Howard “Hap” A. Paul teamed up on custom implant research, developing a robotic system that acted like a CAD/CAM machine.
The pair tested their invention on nearly two dozen dogs before beginning a U.S. Food and Drug Administration (FDA)-approved human trial in November 1992.
“Maybe we can help do current operations better,” Bargar said after the first successful ROBODOC hip implant procedure. “There may be new operations never attempted because you didn’t have this kind of tool. People from all over the world are calling me with phenomenal ideas. It’s very exciting to think this technology may have a lot bigger consequences than cementless hips.”
Bigger, indeed: The consequences of robotic surgical technology has far exceeded expectations, extending well beyond the body’s largest ball-and-socket joint to impact treatment for heart disease, digestive disorders, bladder and kidney conditions, and reproductive system ailments. Yet the technology has grown most rapidly in orthopedics over the last three decades due to its capacity for improved surgical and spatial accuracy, more reliable and reproducible outcomes, and better overall bone preparation.
That growth intensified this year as orthopedic implant companies escalated their battle for market supremacy. Industry heavyweights Stryker Corp., Zimmer Biomet Holdings Inc., and Smith+Nephew plc complemented their growing robotics portfolios with new offerings and partnerships, while smaller players continued to build their lineups to remain relevant.
Stryker won FDA 510(k) clearance of and launched spine guidance software for patients aged 13 and older. Featuring new optical tracking options via a redesigned camera and algorithms of the company’s Spine Guidance software, the Q Guidance system is designed to incorporate robotics and intelligent handheld instruments in the future.
Over six months, Smith+Nephew launched RI.HIP NAVIGATION, RI.HIP MODELER, “cementless” CONCELOC advanced porous titanium 3D printing technology with the LEGION CONCELOC cementless total knee, and LEGION revision knee, all of which are supported by the CORI surgical system.
Zimmer Biomet and the Hospital for Special Surgery (HSS), meanwhile, teamed up to create the HSS/Zimmer Biomet Innovation Center for Artificial Intelligence in robotic joint replacement. The companies aim to develop decision support tools, powered by data collection and machine learning, to provide data-driven recommendations to surgeons for robotic-assisted joint surgery.
Accelus, eCential Robotics, Microport Navibot, and Point Robotics Medtech Inc. each earned FDA 510(k) clearances for their respective robotics-related innovations, strengthening their market footprints. Accelus received the agency’s blessing for its Remi Robotic Navigation System software update that allows image capture with the GE OEC 3D, Ziehm Vision RFD 3D, and Stryker Airo TruCT systems. eCential won authorization for its 3D imaging, navigation, and robotics guidance system, and Microport Navibot gained consent for the SkyWalker System, a robot-assisted platform offering a total knee replacement solution that is compatible with the Evolution Medial-Pivot Total Knee System.
Point Robotics’ POINT Kinguide Robotic-Assisted Surgical System is the first surgical robot developed by a Taiwanese medtech firm to earn FDA clearance. The system also is touted as the world’s first hand-held robot framework equipped with a parallel manipulator for orthopedic application.
Finally, ROBODOC’s current owner, THINK Surgical, raised $100 million to accelerate commercialization of its robotic surgery products, and forged a development and distribution agreement with Curexo Inc. The two firms will work to include certain existing THINK technology and certain newly-developed technology in Curexo’s CUVIS-Joint orthopedic surgical robot platform.
THINK Surgical will have exclusive rights to distribute the CUVIS-Joint robotic platform, including the additional technology, in the United States and other countries including the U.K. and certain countries in Europe. The CUVIS-Joint robotic platform currently is used in Korea and India.
“CUVIS-Joint is the next generation of active robot for joint replacement featuring an open implant library,” THINK Surgical president and CEO Stuart Simpson said. “As an open system that works with implants from multiple manufacturers, CUVIS-Joint is an outstanding fit within THINK’s portfolio of products and services. THINK’s open systems, including the CUVIS-Joint, offer a compelling alternative to closed systems, which are limited to one manufacturer’s implants.”