Robots keeping the next generation of spine surgeons out of ASCs

Robotic technology is growing among spine surgeons, and fellows are learning to use the technology for more precise outcomes. But if they become too reliant on robotics for spine surgery, the transition to outpatient surgery centers could be problematic.

Most spine ASCs don't have the budget for robotic technology since it increases the cost per procedure without commanding higher reimbursement from payers. Hospitals are willing to pay for the robotic systems to attract surgeons and patients to their spine centers, but that isn't an option for ASCs operating on thin margins, especially if the technology is proven to provide only minimal value for experienced surgeons.

"Currently advanced enabling technology, including intraoperative 2D imaging, navigation, robotics and augmented reality, are cost-prohibitive in the ASCs," said Frank Phillips, MD, director of the division of spine surgery at Rush University Medical Center in Chicago. "Many younger spine surgeons are dependent on these technologies to perform more complex spinal procedures. Evolution of these platforms with an eye on the ASC will undoubtedly allow for more migration of more complex cases to the ASC."

Kern Singh, MD, co-director of the Minimally Invasive Spine Institute at Rush said he thinks it will be challenging for young surgeons to transition spine cases to the ASC unless they are confident performing the procedures without robotics, which could hinder spine's overall outpatient migration.

"If you become too heavily reliant on expensive technology, then the transition to the outpatient arena will be very difficult," said Dr. Singh. "ASCs don't have the resources or capital to spend a million dollars on the robot when the procedures can be performed without that system. Unless the price drops, which I doubt since hospitals are willing to pay it, the transition will be more painful."

There are seven spine robots on the market today competing for surgeons' attention. The technology aims to limit radiation exposure and improve precision for less invasive spine procedures, which means quick recovery for patients. Beyond the high costs, there is a steep learning curve for spine surgeons incorporating the technology into their practices.


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