Revolutionizing Spine Care…Changing Lives

Dr. Isador Lieberman: A Pioneer of Robotic Surgery Looks to the Future

In a remarkable “sign of the times” for surgery, the Senhance robot recently became the first new robotic surgical system to receive FDA approval since 2000. According to an article in “Health Care Business,” during the procedure, “the surgeon sits in an ergonomically comfortable position and can see inside the patient’s body via 3D visualization. Senhance’s optical sensors enable them to move the camera and select commands by moving their eyes.”

This robotic, vision-directed surgery represents an exciting new horizon for all surgery, especially spinal procedures because it is minimally invasive. Dr. Isador Lieberman is a pioneer of robotic surgery and partner at Texas Back Institute. He remembers his first experience with this technology.

The Spine Robot

“About 18 years ago, I was challenged by the chairman of my department to come up with an idea for using robotics in spine surgery,” Dr. Lieberman said. “A philanthropic entity offered to make a matching grant to a university in Haifa, Israel on the application of robotics in spine surgery. The chairman of the department asked me to develop a proposal, which I completed and then promptly forgot about it! Several months later, I found that we had received a substantial grant to work on this robotics project, which got the nickname of ‘Einstein.’

“The real genius behind this work is professor Moshe Shoham from Technion University in Israel. I predict he will eventually win a Nobel Prize because of his brilliance. He is responsible for putting together most of the unique aspects of this surgical planning tool.

“This equipment marries a preoperative CT scan with intraoperative x-rays that accurately show the spine in a three-dimensional state. It enables the robot to place the spinal screws necessary for stabilization in the exact place where the surgeon planned on the CT scan. This has proven to be a remarkable advance.”

Planning for Spine Surgery

Dr. Lieberman uses this tool often.

“On a typical Sunday afternoon, after the Cowboys have won, I sit down and plan all of my surgeries for the coming week,” he said. “I consider questions such as where I need to reshape or remove bone and where the screws are going to be placed.”

“I save that plan and the next day take it to the operating room and then load it into the robot. It then does its registration, compared to the CT scan, and points me in the right direction as to where to place the screws. This increases the efficiency and the accuracy of surgery.

“This tool is now being used all over the world. Plus, there are several other robots that are available to spine surgeons, as well. The one that I was involved with is one of three that are commercially available today.”

How Robotics Enable Minimally Invasive Surgery

In many ways, the “holy grail” of surgery – especially spine surgery – is a procedure that is “minimally invasive.”  Dr. Lieberman explains why.

“The concept of minimally invasive surgery involves minimizing the collateral tissue damage of surgery,” Dr. Lieberman said. “Our goal is to target the pathology in the most efficient and precise manner. Once the surgeon is working on the specific area, he or she is able to address this pathology and protect all of the other surrounding tissue. With less tissue damage, there is less likelihood of infection and other complications of surgery. The recovery time is also reduced.

“With the robot, I preplan the surgery in a virtual environment. I have the patient’s CT scan, and I can download this to my laptop. With this process, I know exactly where I need to make an incision and the exact size the screws should be and where the best bone is to attach them.”

“One of the misconceptions about surgical robotics is that the robot actually does the surgery, however, the surgeon is doing the surgery, and the robot is facilitating that preoperative planning and making it more accurate.”

Vision-Directed Robotic Surgery

The latest robotic procedure to be approved by the FDA has the unique advantage of the procedure being guided by the surgeon’s vision. While this seems revolutionary, in fact, the process has been used for many years in other medical applications.

“Today we are very privileged,” Dr. Lieberman said. “There is all this amazing technology available, and we are only limited by our imaginations. Our challenge is to decide on how we are going to use this technology.”

“Using vision-directed apparatus technology is not really a new concept. In the operating room, one could harness what the surgeon sees in multiple views. As his eyes move, an electrical signal can be tracked, and it can translate that into a signal for the robotic device to move. It is another step in this robotically directed procedure.”

What’s Next?

Dr. Lieberman is gifted with a very robust vision of the future of medicine. As such, it is always interesting to ask him what he sees in his “crystal ball” with regards to robotics and surgery.

“I get very excited about the medical advantages of this technology in remote surgery. I can envision being in Texas and operating on someone in Africa. It will require the correct surgical tools and multiple modalities – sight, remote control, sensory or touch apparatus – but the surgery can be completed over a vast distance and help patients who do not have this expertise available to them.”

“At the present time, we are using robotics for the placement of screws,” Dr. Lieberman said. “In spine surgery there is so much more that we can do – cutting bone, trimming away herniated discs, placing cages and other surgical tasks. All of these procedures can be done with robotics, and I’m sure that will be a reality in the next one to three years.”

“Even beyond that, the technology is going to be such that (potentially) I can be seated in a control room and have three or four surgeries going on simultaneously. This is because (in this hypothetical scenario) I have already planned the surgery and I know what I want to accomplish with the procedure. It is at this point that I become the conductor of an orchestra – controlling each of the musical (surgical) instruments from a remote position. The process of surgeons helping patients can be increased exponentially.”

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