Interview with Sébastien HENRY, Founder & CEO of Pixee Médical, France.

Question: Is robotics a true revolution – set to change orthopaedic surgery completely? What does it actually give us that surgical navigation doesn’t?

Robotics presents are real potential in several surgical domains where we can easily imagine its clinical advantages in terms of precision.  The question remains in regard to orthopaedic surgery.  Let’s not forget that a robot is really navigation plus a robotic arm. Was the failure of navigation in the 2000s down to precision of incisions?  Of course not!

How then can we explain the interest in this technology in the orthopaedics field?  In my opinion it is a combination of hospitals’ and surgeons’ need to stand out in the highly competitive US market and that of Majors looking to differentiate themselves from their competitors. While robotics has achieved some encouraging results compared to traditional operating techniques, it has yet to completely prove its significant advantages over other, much less costly, navigation solutions.

Q: How involved are the Major orthopaedic companies in robotics?

The American Majors have been obliged to follow Stryker’s offensive in its take-over of Mako –examples include Zimmer-Biomet’s take-over of Medtech or Smith & Nephew with Blue Belt Technologie for lower extremities surgery. The same can be seen with spine surgery in the Medtronic/ Mazor partnership. All the majors are, to a greater or lesser extent, involved in robotics projects, in the short or medium term. However it’s a defensive strategy which has led these companies to investing in these projects.

Q: Will the challengers follow the majors’ “robotics strategy”?

Firstly, it is surprising not to see a pure player in robotic surgery for orthopaedics, which would mean players entering the market with open platforms. The challengers will remain on-hold as very few of them can afford a technology costing one million dollars per site. With a product open only to one range of implants it will be very difficult to ensure an adequate return on investment and not seriously impair margins in the sale of implants. All this in the context of global reductions in reimbursements for implants. Mako has a ‘first mover advantage’, which will not necessarily benefit others.

Q: Are today’s robotic technologies (both hard and soft) mature enough to meet market needs?

The robotic technologies used are basically those of navigation in the 2000s.  From this point of view therefore there are no technical obstacles. The precision of robotic arms is quite sufficient for existing needs.  It’s surprising to see no evolution in 3D tracking systems which still use the infrared stereo vision camera.  In my opinion IT vision processing holds out real development prospects in this field.  While technology does not impede the development of robots, miniaturization remains an issue as a robotic system’s footprint is too great.

Q: What is the reality of the use of robotics in orthopaedics and what are the prospects for the future?

Things are at present in a state of effervescence similar to navigation in the 2000s or even personalized guides in the early 2010s. Actual use is difficult to quantify beyond announced systems installations, mostly in the USA, Australia, Germany and the UK. We are still a long way from a care standard in orthopaedic surgery. Less than 5 years from now, unless these systems change significantly, we will probably no longer be talking about robotics in the same way. One relevant prospect for improvement would be to integrate AI programs to assist surgeons in their decision-making. This is the approach claimed for the surgical robot project led by Alphabet and J&J. That is, unless the bright future claimed for augmented reality very quickly leads to robotic orthopaedic surgery for dinosaurs unable to adapt to their environment.