Scott Webb (Host): Robotic-assisted surgery for hip and knee replacements is fairly common, but my guest today is here to discuss how robotics are being used for shoulder replacements at Franciscan Health. I'm joined today by Dr. Bernardo Israel Yahuaca. He's a board-certified orthopedic surgeon with the Franciscan Physician Network, and he's the Medical Director for the Franciscan Health Orthopedic Service Line.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk robots. I get excited anytime I get to talk robots. So, robotic shoulder replacement and what that means. So, let's start there. What is Mako SmartRobotics for shoulder replacement?

Dr. Bernardo Israel Yahuaca: So, it's new exciting technology really. You know, shoulder replacements traditionally, we've been doing "manually" and newer technology with planning, where we can see what it's going to look like before we put it in. And now, the next, you know, phase of this is being able to translate that plan in person exactly.

So, what the Mako robotic system does is it allows us to do that. It basically acts as a check ring. So, where I would normally use a saw or a drill on my own, that's now attached to the robotic arm. And during the planning, we set those parameters, so it physically won't let me drill too far or ream too much bone. So, it really allows us to translate the plan into an in vivo product with more precision.

Host: Yeah. Yeah, it's very cool. And just to, you know, establish for listeners, obviously, the robots aren't performing the surgery. You are performing the surgery. The robot is assisting, as you say, with your tools and things on the end of it. So, it's very cool. Maybe you can just take us through, Doctor, like how does it actually work? I'm sure some diagrams would help, but as best you can in audio form, how does the technology work?

Dr. Bernardo Israel Yahuaca: Like I mentioned, the preoperative planning, that gets done, you know, in the office following a CT scan once the patient's ready for surgery. And basically, that 3D reconstruction that I do, you know, in the office, we develop a personalized surgical plan for that patient, and that plan then gets uploaded to the robotic software. So, it has those parameters of how long the screw should be, where the position should be. And there is some wiggle room, like you mentioned. It's still me doing the surgery. So, if they're in person, I say, "Hey, you know what? I think we're going to be better off sliding it over a little bit." I do have that wiggle room to use.

But essentially, it's kind of like a stoplight. There's red, which is no-go. This is not where we planned it. You can't physically drill or ream past there. There's yellow, where's your wiggle room, and then green, where it matches up exactly where the plan was.

Host: Yeah. I like that. I like using the term wiggle room. You know, that makes sense to laypeople like us. Like, yeah, course, a doc would need a little wiggle room. So yeah, maybe give us a sense then, Doctor, like when we talk about this new technology and the robotic assistance and all of that, how does it really help you and your surgical team? We've established you get some wiggle room. That's awesome. But just generally, how does it help you?

Dr. Bernardo Israel Yahuaca: The biggest thing is that it allows us to take the plan of where those implants were going to be and exactly match that to the in-person. So prior to this, even if I am planning it, it's all based on feel, look. There's no exact science to it where I'm not measuring with a ruler, "Hey, this is how far we had it here."

Host: Okay.

Dr. Bernardo Israel Yahuaca: The nice part about this is that it literally takes that 3D reconstruction and we make it a real-life shoulder replacement.

Host: Yeah. Just sort of picturing it in my head. No offense, I don't want shoulder replacement surgery, but I'm picturing, I'm like, "That's pretty cool. I like that." So, give us a sense then, doctor, from the patient's perspective, what they can expect during and after a robotic shoulder replacement.

Dr. Bernardo Israel Yahuaca: So, the nice part about this is because of that direct translation, we're able to be more accurate in the positioning of these implants where we feel this is going to lead us into the postoperative is better outcomes. Ideally, the more precise, the more accurate we get, and the more reproducible these replacements are, the better and better those patients are going to do after surgery. There's going to be less outliers, you know, more consistency.

Host: Yeah, and I don't know, does it also include maybe smaller scars, faster recovery, those sort of music to our ears kinds of concepts?

Dr. Bernardo Israel Yahuaca: Right. I think eventually we'll get there. And what we've seen kind of mirroring the hip and knee replacement side of things, because they've been ahead of us, the shoulder surgeries for a few years now, where that's really become the mainstay, is robotic-assisted using the same Mako robot.

So, seeing that trajectory that they took, I think similarly we're going to see that in shoulder replacements that yes, hey, the patients are recovering faster. There's less bone loss, there's less bone that we're taking at the time of surgery, which would translate hopefully into less pain, faster recoveries, and eventually, yeah, ideally minimally invasive things where we could have those smaller scars.

Host: Yeah, it's really fun to think about just how fast medicine and technology and science, how it all changes, how it affects folks. As you say, knee surgeries were a little bit ahead, but now shoulder's catching up. And I'm sure everyone's benefiting from those experiences and the data and all of that. So, let's just talk maybe just like the major benefits of this technology for you, for patients, their families, their pickleball games, whatever it might be.

Dr. Bernardo Israel Yahuaca: Right, right. I think, at the point where it is right now, the most benefit I see is better ability to account for abnormal anatomy. So, if somebody's shoulder is significantly different or there's some abnormality there, whether that's from an injury or previous surgery or something, this allows me to better account for that.

I think it also gives us more reproducibility in the implant position and the shoulder replacements we're doing, and better preservation of the available bone there by taking less.

As far as patient benefits, you know, at this point, we don't have any literature that shows us, hey, you're for sure going to have a better outcome with this. But like I mentioned, I think it's mirroring the hip and knee world. And I think we will see better outcomes by having these more reproducible and, ideally, faster recovery and less pain. We just haven't seen that yet because it really is very early in the course of this.

Host: Right. It sounds like just a matter of time. No pressure, of course.

Dr. Bernardo Israel Yahuaca: Right.

Host: But yeah, it sounds like a matter of time, and that's great for patients and families and recovery and all of that. Let's just finish up here today, Doctor. Good stuff, really educational. Are there any conditions maybe that would make someone, let's say, not eligible for this surgery?

Dr. Bernardo Israel Yahuaca: Great question, Scott. So, at this point, using the robotic as an assist, I'm able to do most of the replacements using it. The main thing that a patient wouldn't be a candidate for would be if they already have a shoulder replacement in, and this would be a revision or a redo. At the time, the software that we have, we can't take out or extract the current implants that they have there on the software. So, that would be the main thing. Otherwise, for our normal, you know, "normal conditions" like arthritis, fractures, bone loss, even if there were previous surgeries without implants in there, those would all be patients that would be candidates for something like this.

Host: Right. Right. It's like in hosting these, I think, "Okay, I don't want this." I like this doctor, but I don't want him to have to do this to me. But if he did, I like the idea of the robots. And as you learn more and do more and replicate it more, it's just going to lead to, again, smaller scars, faster recovery, all that good stuff for patients. So, I appreciate your time and your expertise. Thanks so much.

Dr. Bernardo Israel Yahuaca: I appreciate it. Thank you for having me.

Host: And for more information, visit franciscanhealth.org and search robot-assisted surgery. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.