An Early Adopter’s Experience with the Remi Robotic Navigation System: By Dr. Tien Le, Total Spine & Brain Institute, Tampa, FL

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An Early Adopter’s Experience with the Remi Robotic Navigation System: By Dr. Tien Le, Total Spine & Brain Institute, Tampa, FL
Dr. Tien Le, Total Spine & Brain Institute, Tampa, FL

Robotic-navigated spine surgery is a game changer for patients, surgeons, and OR staff. It provides me with the ability to perform a less invasive surgical procedure with a smaller incision, less operative blood loss, faster recovery time, and shorter hospital stays. Robotic navigation can also increase the procedure’s accuracy, reproducibility, and safety to help enhance patient outcomes and recovery. Plus, the potential for reducing radiation exposure is a huge win for my patients, my staff, and me.

Currently, there are two camps when it comes to robotic navigation – the early adopters who are excited to facilitate the evolution of the technology and those waiting for the technology to evolve so they are more comfortable with it. This second group of surgeons often ask me:

  • “If I’m doing the procedure every day and getting acceptable outcomes, why would I need robotic navigation?”
  • “Is it really more accurate, reproducible, and safer?”
  • “If it is more accurate, is it going to add time to my cases or disrupt my surgical workflow?”
  • “What about setup and teardown time, line-of-sight issues, and any of the other issues I’ve heard about robotics from my colleagues?”
  • And finally: “How do I justify a more than $1 million purchase to my facility?”

All are valid questions, and I believe they have been addressed with the newest technology on the market – Accelus’ Remi Robotic Navigation System. Remi is the next iteration of robotic spinal navigation. It navigates accurately and precisely without the size, cost, and bulk of the current technologies on the market. This makes Remi amenable to use in other facilities such as ambulatory surgery centers.

Like all enabling technology, robotic navigation has its learning curve. For those who have never used robotic navigation, it may take several cases to get comfortable with the technology and to be able to integrate it seamlessly into your surgical workflow. During that time, your cases may take longer as you become familiar with the system. For those with experience using other robotic navigation platforms, I’ve found that your learning curve may be reduced. My first Remi case took longer as I got comfortable with the system, but the additional time has decreased with each case and is time neutral in some cases. However, I’ve been utilizing robotics for almost a decade and picked up on tips and tricks from my past experience that translated well to my Remi surgeries. I’ve also had cases where I spent a little more time with the Remi system on purpose to evaluate the system and the breadth of what it can do. Overall, once you have navigated the initial learning curve that comes inherently with all robotic systems, I find that Remi is efficient once the proper workflow is established. I know time is one of the biggest obstacles for surgeons moving forward with using robotic technology, and I do not feel that was a major concern with my Remi cases.

I’m also honored to be involved with some of the future developments for the Remi system, including the upcoming software update that will improve the time to register a 3D scan, the ability to use Remi with 2D C-arm imaging versus 3D O-arm and newer 3D imaging systems, and eventually the ability to use Remi to help navigate precise interbody placement through a full spectrum of surgical approaches. I truly believe 2D will be the tipping point for robotics in spine surgery, and a huge step in the right direction. Being able to use robotic navigation with 2D imaging will reduce the radiation load for me, my team, and my patients, which is a tremendous win for everyone involved. That will be a significant timesaver in terms of workflow and being able to decrease the risk of infection, contamination and all – it’s a big deal.

Remi is utilized with the LineSider Spinal System, a low-profile system pedicle screw system that facilitates minimally invasive surgery by allowing for small incisions. I appreciate the bite of the system and the confidence it gives you as the screw engages with the pedicle. Utilizing extended tab technology, LineSider provides a nice MIS delivery of pedicle screws.

Remi and LineSider also work well with Accelus’ FlareHawk portfolio of expandable interbody devices for a total MIS procedure solution. FlareHawk is my interbody implant of choice due to multiple factors including a small, tapered leading edge that minimizes collateral neural injury, adaptive geometry that conforms to the endplates, expansion of both height and width, and generous post-packing ability due the lack of mechanical inner components often seen in other expandable technologies.  I’ve implanted more than 100 FlareHawk implants to date.

I have a practice that is minimally invasive based, which is essential to provide my patients with a quicker recovery, less bleeding, less infection risk, and less post-operative pain. MIS spine surgery is here to stay, and I feel robotics will soon play a much larger role in MIS procedures as the technology evolves to reduce radiation exposure for spine surgeons and the procedure becomes time neutral and timesaving.

Given its small size, compact setup, and realistic cost, Remi is well-suited to advance the standard of care for robotic spinal navigation and will play a pivotal role in robotic-assisted spinal surgery in the years to come. Remi augments the well-established benefits of minimally invasive surgery, reducing radiation exposure and allowing for the accurate placement of pedicle screws in otherwise difficult anatomy that may not be well visualized using conventional techniques.

Editor’s Note: Dr. Tien V. Le is a Board-Certified and dual Fellowship-trained Neurosurgeon and a leader in minimally invasive and robotic spinal surgery solutions. Dr. Le earned his bachelor’s degree in Biology from the University of North Florida, where he graduated summa cum laude with Baccalaureate Honors. He received his medical degree at the University of South Florida Morsani College of Medicine (USF), having earned the distinction of Neurosurgery Student of the Year during his senior year. His neurosurgery residency training was done at the world-renowned Cleveland Clinic and USF, where he served as Chief Resident during his final year.

Dr. Le was also chosen by Dr. Kevin Foley, the primary surgeon designer of the Remi Robotic Navigation System, to the prestigious post-graduate Spine Neurosurgery Fellowship at the Semmes-Murphey Neurologic & Spine Institute. Certified for the use of robotic-assisted spine surgery since 2013, Dr. Le recently incorporated the Remi Robotic Navigation System into his spine fusion procedures to navigate the placement of pedicle screws from the LineSider® Spinal System. Dr. Le was also the first surgeon in the world to complete a case with Accelus’ full flagship portfolio including Remi, LineSider and FlareHawk Expandable Interbody Fusion Implants.