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Leopold SS, Dobbs MB, Gebhardt MC, Gioe TJ, Manner PA, Porcher R, Rimnac CM, Wongworawat MD. Editorial: What CORR® Seeks From Papers About New Implants and Techniques. Clin Orthop Relat Res 2022; 480:1843-1845. [PMID: 36036757 PMCID: PMC9473788 DOI: 10.1097/corr.0000000000002376] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Seth S. Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Matthew B. Dobbs
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Mark C. Gebhardt
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Terence J. Gioe
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Paul A. Manner
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Raphaël Porcher
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
| | - Clare M. Rimnac
- Senior Editor, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA
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Powers B, Smith CD, Arroyo N, Francis DO, Fernandes-Taylor S. How Do Academic Otolaryngologists Decide to Implement New Procedures Into Practice? Otolaryngol Head Neck Surg 2021; 167:253-261. [PMID: 34546818 DOI: 10.1177/01945998211047434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify barriers and facilitators to adoption of a new surgical procedure via an implementation science framework to characterize associated socioemotional, clinical, and decision-making processes. STUDY DESIGN Qualitative study with a semistructured interview approach. SETTING Large tertiary care referral center. METHODS Academic otolaryngologists with at least 2 years of practice were identified and interviewed. Transcripts were thematically coded and separated into steps in the clinical pathway. Synthesis of major themes characterized facilitators and barriers to uptake of a new surgical technique. RESULTS Of 22 otolaryngologists, 19 were interviewed (85% male). They had a median 18 years of practice (interquartile range, 7.8-26.3), and 65% were subspecialty trained. In the decision to implement a new procedure, improving patient outcomes and addressing unmet clinical needs facilitated adoption, whereas costs and adopting profit-driven technologies without improved outcomes were barriers. In patient consults, establishing trust facilitated implementation of new techniques; barriers included participants' hesitation to communicate about the unknowns of a new procedure. Intraoperatively, little change to existing workflow or improved efficiency facilitated adoption, while a substantial learning curve for the new procedure was a barrier. Achieving favorable outcomes and patient satisfaction sustained implementation of new procedures. Too few referrals or indications for the new procedure hindered implementation. CONCLUSION Our study demonstrates that innovation in otolaryngology is often an individual iterative process that providers pursue to improve patients' outcomes. Although models for the oversight of surgical innovation emphasize the need for evidence, obtaining sufficient numbers of providers and patients to generate evidence remains a challenge in specialty surgical practice.
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Affiliation(s)
- Bethany Powers
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cara Damico Smith
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - David O Francis
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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Hussain A, Nijhawan N, DeAngelis D, Oestreicher J. Perceptions and use of computer-assisted surgery (CAS) in the orbit. Orbit 2019; 38:180-183. [PMID: 29993308 DOI: 10.1080/01676830.2018.1490440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
Computer-assisted surgery (CAS) plays a prominent role in certain surgical disciplines. We investigated the current perceptions and use of this technology for orbital surgery. An online survey was emailed to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Society of Oculoplastic Surgery, and British Oculoplastic Surgery Society. Respondents were asked to describe their practice type and seniority, their frequency of orbital surgery, experience, use, and accessibility of CAS, and their opinion on the technology. There were a total of 151 responses across the societies. 105 respondents (69.5%) had been in attending/consultant practice for over 10 years, with over half (54.7%) working in academic/teaching hospitals. The majority (66.7%) had superficial or no experience with CAS. In total, 84.8% of respondents rarely or never use CAS for orbital surgery (n = 128). Posterior orbital surgery (64.2%) and orbital decompression (49.0%) were the two most useful reasons to implement CAS. Longer operating time (58.3%) and cost (54.8%) were the two most selected weaknesses for CAS, whereas improved accuracy in attaining surgical end point(s) (80.8%) and patient safety (63.6%) were the principal advantages. Type of practice was significantly associated with CAS availability/accessibility (p < 0.05). Proportion of orbital surgery performed in practice was significantly associated with both CAS experience and use (p < 0.05). Our study confirms an expected variation in the perception and use of CAS for orbital surgery. Demonstrated patient benefit and integration of refined and cost-effective CAS systems into operating room environments may influence its future role.
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Affiliation(s)
- Ahsen Hussain
- a Department of Ophthalmology and Visual Sciences , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Navdeep Nijhawan
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
| | - Dan DeAngelis
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
| | - James Oestreicher
- b Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Ontario , Canada
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Lewis TL, Furness HN, Miller GW, Parsons N, Seers K, Underwood M, Metcalfe AJ. Adoption of a novel surgical innovation into clinical practice: protocol for a qualitative systematic review examining surgeon views. BMJ Open 2018; 8:e020486. [PMID: 29666134 PMCID: PMC5905758 DOI: 10.1136/bmjopen-2017-020486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Efficient adoption of clinically effective novel surgical innovations has great potential benefits for patients. Factors affecting the adoption of surgical innovation are not well understood and proposed models of adoption do not accurately correlate with historical evidence. This protocol is for a systematic review that aims to identify the qualitative evidence relating to surgeon views regarding the adoption of novel surgical innovation into clinical practice. METHODS AND ANALYSIS A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be performed. Two independent reviewers will search the following databases: MEDLINE, Embase, Science Direct, Scopus, Web of Science and the Cochrane Library of Systematic Reviews. Inclusion criteria are studies which report on the views of surgeons who adopt a novel surgical innovation into clinical practice. Each article will be screened for inclusion and assessed according to a Critical Appraisal Skills Programme tool. Data will be synthesised and analysed according to thematic analysis. Given the anticipated yield of a small heterogeneous body of evidence meeting the eligibility criteria for the review, a narrative-based summary is planned. ETHICS AND DISSEMINATION This review does not require formal ethical approval as it does not involve direct patient contact or patient-identifiable data. The results of this review will be published in a peer-reviewed journal and presented at relevant conferences. The results will also inform an empirical qualitative study exploring surgeon and other stakeholder views regarding the introduction of novel surgical technology and procedures into clinical practice. PROSPERO REGISTRATION NUMBER CRD42017076715.
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Affiliation(s)
- Thomas L Lewis
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry & Warwick, Coventry, UK
| | | | | | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew J Metcalfe
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry & Warwick, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Abstract
THINK Surgical TSolution-One® is an active-autonomous, image-based, robotic milling system which enables the surgeon to attain a consistently accurate implant component positioning. The TSolution-One® system is capable of achieving this through an image-based preoperative planning system which allows the surgeon to create, view and analyse the surgical outcome in 3D. The accuracy and precision of component positioning have been attributed to the following factors: customized distal femoral resection, accurate determination of the femoral rotational alignment, minimization of errors and maintenance of bone temperature with robotic milling. Despite all these advantages, there is still a paucity of long-term, high-quality data that demonstrates the efficacy of robotic-assisted total knee arthroplasty (TKA). Questions regarding radiation risks, prolonged surgical duration and cost-effectiveness remain unanswered. This paper aims to describe: (1) TSolution-One® surgical technique; (2) limitations and complications; (3) clinical and radiological outcomes.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865
| | - Pak Lin Chin
- The Orthopaedic Centre, Mount Elizabeth Medical Centre #08-02, 3 Mount Elizabeth, Singapore 228510
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865
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Jaiprakash A, O'Callaghan WB, Whitehouse SL, Pandey A, Wu L, Roberts J, Crawford RW. Orthopaedic surgeon attitudes towards current limitations and the potential for robotic and technological innovation in arthroscopic surgery. J Orthop Surg (Hong Kong) 2017; 25:2309499016684993. [PMID: 28142353 DOI: 10.1177/2309499016684993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To determine the perceptions of surgeons at both consultant and resident level to the difficulties of performing knee arthroscopy and to determine their willingness to adopt robotic technology. METHODS A questionnaire was designed to discern the attitude of orthopaedic consultants and residents to the technical challenges of performing knee arthroscopy and the possible role of robotically enhanced surgery. The questionnaire included 31 questions across five key domains. RESULTS Iatrogenic damage to articular cartilage was thought to occur in at least 1 in 10 cases by 50% of respondents with 15% believing that it occurred in every case. One hundred or more procedures were thought to be necessary to overcome the learning curve by 40% of respondents and 77.5% believed that 50 procedures or above were necessary. Ninety-nine per cent of respondents agreed that higher technical skills would decrease unintended damage. Despite such difficulties with the procedure and no prior experience with robotic surgery, 47% of respondents see a role for semiautonomous arthroscopic systems in the future. CONCLUSIONS Surgeons believe that knee arthroscopy is a difficult procedure with a long learning curve and a high incidence of iatrogenic cartilage damage. Many find it ergonomically challenging and have frustration with current tools and technology. CLINICAL RELEVANCE This is the first study that highlights surgeons' difficulties performing knee arthroscopy despite the commonly held attitudes that it is a straightforward procedure. Systems that are able to decrease these problems should improve patients' outcomes and decrease the risk of harm.
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Affiliation(s)
- Anjali Jaiprakash
- 1 Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - William B O'Callaghan
- 2 Department of Orthopaedic Surgery, Prince Charles Hospital, Chermside QLD, Australia
| | | | - Ajay Pandey
- 1 Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Liao Wu
- 1 Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Jonathan Roberts
- 1 Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Ross W Crawford
- 1 Queensland University of Technology (QUT), Brisbane, QLD, Australia.,2 Department of Orthopaedic Surgery, Prince Charles Hospital, Chermside QLD, Australia
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Abstract
Precise and accurate biomechanical reconstruction during total hip arthroplasty (THA) is essential for durable long-term survivorship. Accurate fit of cementless hip implants is also crucial to reduce micromotion between the bone-implant interfaces to allow for stable osseointegration. Robotic technology aims to minimize potential human errors and improve implant alignment and fit, and address persisting concerns with modern-day cementless THA. Although robotic THA dates back to the early 1990s, concerns with increased operating times, costs, and complications led to its withdrawal. However, semi-active systems have renewed interest in robot-assisted joint arthroplasty. We reviewed the current technology, its potential benefits, and the reported clinical and radiographic outcomes. Early evidence suggests that robotic use may lead to more accurate reconstruction of radiographic parameters, such as implant positioning, fit, center-of-rotation, and leg-length discrepancy. Further research is needed to determine if these will translate into better outcomes and improved implant longevity to justify increased costs.
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Affiliation(s)
- Samik Banerjee
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Jeffery J Cherian
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Randa K Elmallah
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Todd P Pierce
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Julio J Jauregui
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Michael A Mont
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
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Abstract
Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost-benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation.
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Affiliation(s)
- Samik Banerjee
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Jeffrey J Cherian
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Randa K Elmallah
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Julio J Jauregui
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Todd P Pierce
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
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Lehoux P, Miller F, Hivon M, Demers-payette O, Urbach D. Clinicians as health technology designers: Two contrasting tales about user involvement in innovation development. Health Policy and Technology 2013; 2:122-30. [DOI: 10.1016/j.hlpt.2013.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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