WHAT THE DOCTOR ORDERED
Dr. Michael Karch is getting by with a little help from his friends.
Robotic-assisted help, that is.
This year, Mammoth Hospital became one of the first facilities in California to invest in the implementation of the DePuy VELYS Robotic Assisted Solution for Knee Replacement. It’s a new technology—one that uses a high-speed camera, hydrophobic optical reflectors, and an optically tracked calibrated probe to collect information on a patient’s bone anatomy and soft tissue.
“The nitty gritty is this,” said Karch. “We make a standard incision, just like you normally would. Then I put in four pins—two into the femur, two into the tibia. Then, I attach an electrical array and take the knee through a range of motion. The robot is kind of sitting on the side of the table, and it’s picking up 130,000 data points in probably two minutes on that patient’s specific knee.”
This intraoperative collection of data is revelatory to a surgeon, who, to borrow Karch’s phrase has to “eyeball” much of a surgery’s angularity and measurements, absent of generated data. Not only does that data reveal optimal alignment or implant size, but the aggregate is also used to determine an initial plan of procedure for the operating surgeon. The surgeon can then determine whether to accept the recommended procedure, or modify its components, all the while receiving feedback in real time for the desired outcome of joint balance and alignment.
So, why is this important? As Karch explained, prior to the tech’s implementation—what he refers to as navigated or robotic knees—all anatomies were treated more or less the same.
“We were putting everybody into the same size shoe,” said Karch. “But there’s no one knee that’s the same as another.”
As Karch explained, patient satisfaction rates for knee replacement surgeries are variable, with roughly 20% of patients, post-op, reporting dissatisfaction with their outcomes. In a ski town like Mammoth, Karch estimates that that percentage is likely skewed right.
“The population that lives in and around Mammoth want to get back to skiing and snowboarding,” said Karch. “These are, by definition, higher demand people with higher demand knees and greater deformity.”
For both those patients and others, with the patient specificity of robotic-assisted surgeries comes faster recovery times, and vastly improved clinical outcomes when compared to a traditional, measured resection technique. An article published in the Surgical Technology International scientific journal last year on the VELYS Robotic-Assisted Solution reported the statistic of a “100% satisfaction trend” by patients after one year, and less pain and improved function earlier in recovery.
“The trauma is less. The recovery is faster. The outcomes are better,” said Karch. “But the most important thing, honestly, for me is coming out of surgery and knowing I’ve hit a home run every time.”
And the more home runs that individual orthopedic surgeons, themselves, score, is all the better for the game. In other words, the more surgeons that apply this technology in their respective ORs, and the more cases that contribute information to the aggregate data, the better the technology becomes. Information collected from robotic-assisted surgeries essentially gets uploaded to a cloud system, from which a bell curve of sorts can be constructed. Artificial intelligence (AI) is then utilized to sort through the vast reams of recorded data to determine a range of knee health and anatomy—the center of which, the highest point of the bell’s contour, is a perfect knee.
And implementing the robotic-assistance and data collection to a surgical plan adds, on average, 30-40 minutes to a knee replacement—a procedure which traditionally requires under an hour and a half in the operating room. But according to Karch, that extra time adds assurance that’s critical to a surgeon’s confidence.
“Everything’s a mental game,” said Karch. “You walk out and you think ‘Damn, we nailed that one. Let’s go do another.’”
Because as Karch explained, surgical outcomes commend quality, over quantity. That can be a tough sell in the economics of modern medicine, but one that Karch feels Mammoth Hospital has been receptive to in recent years.
Karch, who prior to VELYS was no stranger to the deployment of innovative medical tech (the doctor holds a number of medical device technology patents under his name and co-invented an intelligent orthopedic surgical drill, Smart-Drill, back in 2019), credits much of the hospital’s success in technological innovation to the open-mindedness of its board, and the willingness of both its surgeons and patients.
Said Karch: “We’re at this beautiful intersection right now between human learning and machine learning. Machines learn by data. Humans learn by experiential and emotional learning. So it’s not that the machine is better than the human, or that the human is better than the machine. It’s when you put the two together that you get something superior to each individual. And that’s a convincing argument.”
Karch, who is working toward the release of his second book, Artificial Intelligence for the Everyday Person (his first came out just last week, and is called Tangible Heroes: Coaching for Success) is optimistic about the future possibilities in using robotic navigation and artificial intelligence in medicine. But he acknowledged that they’re just that—possibilities.
In implementing the technology to a knee replacement—a surgery involving 107 steps from cut to close—Karch emphasized that preparedness is critical, and that young doctors still in their residency must receive training in both assisted and traditional surgical methods.
“Because what happens if the lights go out?” asked a rhetorical Karch. “What happens if it fails? The mentality of a surgeon is always Plan A, Plan B, Plan C, Plan D. You have to be ready.”
When we spoke, Dr. Karch was finishing up his chapter on ethics to be included in his upcoming book. As we discussed, the ethical dilemmas associated with artificial intelligence are compelling. AI is, afterall, a summative data set of the human experience. It’s revelatory, and it’s vast. But increasingly, it has demonstrated a capacity for bias and a propensity for the perpetuation of socioeconomic disparity.
“This kind of transformative technology should leave no one behind,” said Karch. Fairness, equity—it has the capability to be those things, if we think about it ahead of time.”
Preparedness. Planning. The doctor might be onto something.
