Computer-guided hip surgery using Robodoc put under critical attack in Germany

Berlin 15 January 2004The use of the computer-assisted surgery system Robodoc in German hospitals to replace worn hips probably has led to serious complications and irreparable muscle damage, according to the Dutch professor C.N. van Dijk. Several hundred patients may have turned cripple. The German-American Robodoc system is a fully automated and computer-guided robot which is applied to insert hip prostheses in patients who suffer from arthrosis or have had a hip fracture. Purchase price for the robot is 500.000 euro.

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Professor Dr. Martin Börner from the Berufsgenossenschaftliche Unfallklinik (BGU) in Frankfurt am Main has denied Professor van Dijk's claim and assured that more than thousand patients have been helped excellently using the Robodoc system.

In Frankfurt am Main the accuracy of the computer-assisted surgery system is beyond any doubt. The number of complications does not exceed the amount which is experienced in conventional surgery, according to Professor Dr. Börner who noted that in ten thousand patients who underwent computer-guided surgery, two hundred people were not satisfied. Of course this is too much but proportially still a good result, as Professor Börner explained.

In The Netherlands, many patients are being sent across the boarder by their insurance companies because of a shortage in treatment capacity in the Dutch surgery centres. To date, no Dutch hip prosthesis patient has been complaining about a surgical intervention using Robodoc.

Robodoc could cause severe tissue damage. According to Professor Dr. Reiner Gradinger from the Klinikum rechts der Isar in Munich, a lot of German hospitals have stopped all surgery treatment with Robodoc in the past few years. Professor Dr. Gradinger noted that some six years ago, a great number of German hospitals started working with Robodoc both under the pressure of the Robodoc vendor and to face mutual competition. Since then, many of them have ceased to use Robodoc because the robot is said to damage the patient's muscle tissue and it was found that its steering was not sufficiently accurate. In addition, there are too many lawsuits pending.

Dr. Rudy Nuyts from the University Hospital in Antwerp explains how the Robodoc procedure works. The surgeon plans the operation in the computer. He opens up the patient and leaves the surgery to the robot. Robodoc automatically places the prosthesis in the shaft of the thigh-bone and aligns the ball joint with the acetabular rim or socket in the pelvis. Unfortunately, the robot does not fully take into account the obstacles which are met along the surgical path. He does not "see" the muscles and this might be cause of irreparable damage.

Instead, Professor Dr. Börner considers Robodoc to be "unbeatable" when it comes to fixing hip prostheses. No implanted hip prosthesis has been subject to dislocation up till now, according to Professor Dr. Börner. On the other hand, Professor Gradinger noted that Robodoc never has received approval for clinical use in the United States. Both specialists assume that computer-aided surgery will decrease in Germany. The use of this type of innovative technologies is too expensive and the insurers no longer are reimbursing this treatment, according to Professor Dr. Börner.

According to Dr. Nuyts, there is no reason for very advanced robot use since there are other techniques which are equally efficient but safer. The University Hospital in Antwerp has developed and refined a navigation system in which the computer calculates the exact position during surgery. It is the surgeon who performs the intervention but he is guided by what he sees on the monitor screen. Each year, some 16.000 hip prostheses are being implanted in Belgium. This is an increase by 5 to 10 percent in comparison with the situation ten years ago.


Leslie Versweyveld

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