Joey Wahler (Host): Robotics is being applied in so many areas of medicine, so we're discussing robotic spine surgery. Our guest, Dr. Thomas Andreshak, an Orthopedic Surgeon for Wood County Hospital. This is Health Matters, Insights from WCH Medical Experts. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Andreshak. Welcome.

Thomas Andreshak, MD: Hi, nice to see you.

Host: Same here. So first, what specific advantages does minimally invasive spine surgery with a robot provide compared to traditional spine surgery methods over the years?

Thomas Andreshak, MD: The real advantage is that the placement of the hardware, basically the screws and rods that we use in spine surgery, is in a better and actually more precise location. The robotic spine that we use, that robot at Wood County is called the GPS system, and just like a GPS in a car, you can use a road map, look at a map and figure out where you're going, or the GPS will take you exactly where you want to be.

Host: Great analogy, so are there times when you're using this when, like those of us driving our cars, using GPS, you, you think about how you used to do it the old fashioned way, so to speak, when we used maps, if you will?

Thomas Andreshak, MD: Absolutely, we can do it freehand. We can do it with what we call fluoro, so live x-ray during surgery. But knowing that we have planned ahead of time where we want the screws, and as you can understand, most patients anatomy is different. So it allows us to be really precise, exact, so the patient's recovery is quicker, faster, and hopefully with less pain and no real complications.

Host: You mentioned precise. Preciseness is what doctors seem to talk about all the time when mentioning the advantages of robotics in surgery. So you mentioned this Excelsius GPS system. Give us a little bit more of a detailed idea, if you would, on how it makes your job easier and, through osmosis, how it's better for the patient, of course, as well.

Thomas Andreshak, MD: So the first is the planning hardware software. Patient has a scan. We do a CT type image where the patient's pattern of the spine is projected into the computer. We then plan the route we want to go in terms of where the screws go exactly. And the robot then positions our guide in terms of the drilling, tapping where the screw goes, and placing the screw exactly where it should be. As we know in the spine, there are a lot of valuable structures around it, such as nerves, and we want to make sure we avoid those. So, it makes it more precise in the sense of we know we have patient safety in that respect, and don't injure those surrounding tissues.

Host: And before we go any further, whenever I talk to you and yours about robotic surgery, it's always important, I feel, to point out to people that while it's known as robotic surgery, there are human experts like yourself behind it. So robots haven't taken over the OR, right?

Thomas Andreshak, MD: That is correct. Yeah, the robot guides us in terms of doing the surgery. I am still doing the surgery. I'm still unpinching nerves. I am still actually placing the screws. It's not done automatically, like push a button. Whereas, yes, it's just that precise placement to get my screw where I want it to go.

Host: Gotcha. And so, what types of spinal conditions and surgeries benefit the most from the use of this Excelsius system?

Thomas Andreshak, MD: So the spine surgeries that are best treated are those that require hardware fixation points. Most of these surgeries, in the United States, in terms of lower back surgeries, use what we call pedicle screws, screws that are placed in the spine. So those surgeries are improved. Scoliosis, fractures, and degenerative conditions of the spine.

Host: So, when people hear the term robotic surgery, do you have to put their mind at ease both about the fact that there is still a doctor like yourself behind it, as we said, but also over the fact that it's new technology and people often are leery of anything new and different, right?

Thomas Andreshak, MD: It is new and different, but robotic surgery has been around for us in the spine world for about 10 years, but because there are limitations to it, it's not as easily accepted right away. I do tell the patient, I am doing the surgery, I am guiding it, it is assisting me, but truly, although it's new, like everything else new, innovation. We all have cell phones now, and we all bucked it in the beginning.

Host: And speaking of which, cell phones are a great example of something that is thought of as being relatively new, but not exactly. Kind of like what we're discussing, cell phones, of course, have come a long way since they first came out. How about this technology?

Thomas Andreshak, MD: This technology has improved dramatically also. We now have different technique where we can place the screws without the old methods of using a lot of x-ray. So we decrease the radiation to the patient and ourselves at that same time.

Host: How about, how does the Excelsius system improve the safety of spine surgeries and what kind of an impact does that have on recovery time for patients?

Thomas Andreshak, MD: So especially with the spine, because of the nerves in the spinal canal, spinal cord is in that surrounding area, by placing the screws correctly, which freehand, we call it, how we did old traditional surgery, is about 75 percent accurate. Now that doesn't mean 25 percent have problems, but the robotic spine surgery is over 98 to 99 percent accurate.

So if we don't injure nerves, if we don't have a screw irritating tissues, the recovery is quicker and faster. We don't have to go back and do a revision surgery.

Host: People watching and listening may be curious as to what kind of training a surgeon like yourself needs to be up to date on the latest when it comes to this equipment.

Thomas Andreshak, MD: We have specialized training where we go to a lab and actually work on cadavers, learn the programming of the robotic computer. Very similar to what we do anyway when we do surgical navigation is what we sometimes term it. But basically, the robot then takes the mundane process of getting the exact alignment of drilling for the screw and placing the screw.

So it's a user friendly system, just like the cell phones are pretty user friendly, but there are just little learning techniques that we have to learn.

Host: Any other misconceptions other than what we touched on earlier that patients tend to have about robotic surgery?

Thomas Andreshak, MD: No, the main thing is that they think the robot does the surgery. I'm sitting at a desk pushing buttons and the robot will come in and put screws in, which doesn't occur.

Host: So again, you're not going to be out of a job anytime soon, fortunately, right?

Thomas Andreshak, MD: No, I will still be having a job because I have to guide the robot into the right position.

Host: So any examples of how this relatively new technology equipment has improved the patient experience? Maybe you have a success story or two you can share with us.

Thomas Andreshak, MD: The success stories generally are improved because of patient's mobility. Patients are able to get out of the hospital quicker, return to work quicker and faster because they have less soft tissue damage. Traditional larger open surgery is still done and there's a need for it, but if we can do a minimally invasive type surgery where we spare the tissue damage of the muscles and the surrounding tissues in the spine; patients are able to get to work quicker, recovery quicker, spend time with their family quicker, and have less pain. So therefore, we avoid the opioids, which is another reason to have a minimal surgery if you can.

Host: You're talking there about the ultimate goal, which is to get people back to the quality of life that they were enjoying before they had spinal issues. What are one or two of the things that people tell you they look forward to getting back to most that maybe they haven't been able to do because of the problems they've been experiencing?

Thomas Andreshak, MD: Well, everyone has their recreation they want, whether it's fishing or boating or just spending time with the family. Able to walk is one of the biggest complaints people cannot do from spine surgery, and just being able to walk and get outside, they're so satisfied.

Host: So what kind of a recovery time, generally speaking, are people looking at when they have robotic spinal cord surgery? Obviously, every case is different, but generally speaking,

Thomas Andreshak, MD: Most patients who have usually one or two level spinal surgeries are able to get out of the hospital within the day. Some actually, same day they could leave. Several days of pain, maybe three to five days, but then the pain diminishes and they dramatically feel different just because their spine is stable, not pinching nerves in the surrounding tissues.

Host: Wow, so to be able to go home at times the same day, that's impressive, right?

Thomas Andreshak, MD: It is remarkable when you see those people get up and their leg pain is gone and they're just like, wow, this is really is different.

Host: Couple of other things. Whether it's robotics or the old fashioned system, if you will, am I right that when people hear the term spinal surgery, that can be a little scary, right? So what do you do to kind of calm people's nerves when it comes to that?

Thomas Andreshak, MD: Spinal surgery is terrifying. When you say we're operating on the spine, I'm not having that. No way. I don't want someone touching my spine. But when the patient has that terrible nerve pain, that pain that keeps them from functioning, they essentially have to lay down, sit constantly because they have the pain, we reassure them by the results of the surgery.

We tell them what statistically they will do. That 75, 80 percent will be improved, able to walk, able to return to normal activities. And just reassuring them and convincing them that we're going to do it in a safe, efficacious, and swift manner, with a computer, sometimes it feels safer because it's more precise, and that precision is important in spine surgery.

Host: Absolutely, as you've pointed out. Finally, in summary here, Doctor, how rewarding is it for you to be able to provide this latest technology to patients?

Thomas Andreshak, MD: It is phenomenal to be able to finally do that. Patients are very gracious. They're very thankful afterwards. And you, just the feeling and the elation of them coming in and saying, Oh my gosh, it's like I have my life back. It's just so rewarding and makes it worthwhile to do.

Host: That's great to hear. Well, folks, we trust you're now more familiar with robotic spine surgery. Dr. Thomas Andreshak, keep up the great work. And thanks so much again.

Thomas Andreshak, MD: Thank you. I appreciate the time.

Host: Absolutely. Same here. And you can call Consulting Orthopedics to learn more about this latest approach. They're at 419-353-6866. Now, if you found this podcast helpful, please share it on your social media.

I'm Joey Wahler, and thanks again for being part of Health Matters, Insights from WCH Medical Experts.