LEWISTON – Having surgery soon? A robot can probably help with that.

Robotics-assisted technology is becoming more common in operating rooms across Maine, with St. Mary’s Regional Medical Center in Lewiston recently joining the list of hospitals employing the new methods.

“It kind of is a fundamentally different way of doing a knee replacement,” Dr. Boris Kovalenko, an orthopedic surgeon at St. Mary’s, said earlier this summer.

Kovalenko was standing in an operating room at St. Mary’s, holding what looked more like a tricked-out hot glue gun attached to a rolling TV cart than an advanced piece of surgical technology.

While some surgical robots, like the Da Vinci models found at Central Maine Medical Center in Lewiston, Maine Medical Center in Portland and elsewhere in the state, are large machines capable of performing several types of surgery, the CORI robot is made specifically for total and partial knee arthroplasties, or knee replacement surgery.

With the robot, “we’re able to basically use this technology to figure out what the patient’s native anatomy is, figure out what their (knee bone) anatomy is, their soft tissue anatomy, and use that to determine the optimal way to position these implants,” Kovalenko said.

“Because everyone’s knee is unique, so we’re allowed to basically figure out what’s the best way to cut the bone and put the implant in.”

In a traditional knee replacement, a surgeon makes preliminary cuts, places trial implants and flexes and extends the knee to find the right “balance” of tension on the ligaments that surround the knee, before replacing the end of the thigh and shin bones and part of the kneecap, Kovalenko said.

Through sensors placed in the knee, the robot can graph the balance of the knee as Kovalenko is working. There are also fewer incisions and smaller cuts.

The Da Vinci models employed by CMMC and Maine Med are hulking pieces of machinery in comparison to the small, handheld device at St. Mary’s.

Whereas Kovalenko stands over a patient and has the robot in hand, surgeons using the Da Vinci are somewhat removed from the patient – sitting a few feet away at an enormous console, where they see the high-definition, 3D view of the surgical field from the machine’s cameras and direct its robotic arms.

“The biggest thing about robotics to me, when you apply it to really any field of surgery, is the level of precision that you can dissect with,” said Dr. Blair Baldwin, a bariatric surgeon at CMMC.

“If you look at the tip of your pen or pencil and we think about how small that little area is, that’s kind of the size of the tips of the instruments we’re working with, with robotic surgery.”

Successful surgery requires a surgeon’s deft hands, Baldwin said, “but smaller, more-precise hands are even better. And that’s why I love it.”

This kind of surgery, where the surgeon is directing the machine from a separate console, takes some getting used to, according to Dr. Matthew Hayn, a urologist at Maine Med.

With the robot, “it’s a different experience,” Hayn said. “You can’t feel anything with the robots. There’s no tactile feedback, no haptic feedback, so you sort of have to train your brain to rely on how things look when you move, like these visual cues.”

Feel is important to a surgeon, often because it is not so easy to see the surgical field.

“You see things better robotically,” Hayn said, “and you see everything magnified and in 3D which, in my mind, kind of makes up for that lack of being able to feel. It’s a trade-off. But once you learn how to do it, it’s not a big deal.”

While the level of precision and minimally invasive approach to surgery are huge pluses for these surgeons, they are not altogether convinced it is better than the “old-fashioned way.”

“I think I can do a good knee replacement either way,” Kovalenko said, and it is not necessarily faster.

Baldwin said he is worried overreliance on new technology, especially as it continues to develop, could mean loss of the patient-provider connection, which he said is especially important during recovery.

This technology is expensive, too. The Da Vinci robot cost an estimated $2 million in 2020, according to the scientific journal Nature.

Hayn said there are significant ways in which robotics-assisted technology is “a game changer,” especially in urology, where some open surgeries have a high risk of blood loss and longer post-surgery hospital stays.

“It allows us to convert some cases that could only be done open,” Hayn said, “to now minimally invasive just because of the sort of nuances of how the robot works.”

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