500+ bedded multi-speciality and tertiary care centre, Sunshine Group of Hospitals, was founded in 2009, in order to offer enhanced care to its patients with a focus on clinical excellence. With expertise in joint replacement procedures, this Hyderabad-based hospital has been providing a qualitative medical facility to its patients.
The centre, with 30+ specialities, under the leadership of Dr AV Gurava Reddy, performs 4,000 joint replacements surgeries, including hip, knee and shoulder, both primary and revision in a year, and therefore has become the second-largest Joint Replacement Centre in South East Asia with patients coming from countries like Canada, USA, Sri Lanka, Bangladesh, Iran and majority of the African countries are being treated here. With NABH accreditation, Sunshine Hospitals claims to have a commitment towards clinical excellence, patients’ safety & dignity, transparency and affordability for patients.
The Challenge
Being one of the most famous hospitals in Hyderabad for joint replacement surgeries, the hospital attends numerous joint operations regularly. The hospital has been running on the conventional method of knee replacement since its inception, where doctors use manual techniques to cut soft tissue and bone of patients and replace the same with prosthetic components, which has proved to be beneficial for many of its patients and allowed them to continue their life without any problems. However, there was still scope for improving the accuracy of performing these procedures.
With traditional methods, the surgeons would manually make an incision for the surgery, which also can result in significant blood loss, and thus require more recovery time for patients.
According to AV Gurava Reddy, Managing Director and Chief Joint Replacement Surgeon at Sunshine Bone and Joint Institute “Even with the advancements in conventional joint replacement surgeries, 20% of knee patients are not satisfied after a knee replacement.”
This can also be attributed to its success rate, which is 95%, and that’s where the hospital realised the importance of robotics technology which ensures a 100% precision. Moreover, the patient outcome is much satisfactory in the case of robotics surgeries.
Deployment Of The Solution & Benefits
With each patient having different bone anatomy, and joint disorders like arthritis further tend to alter the anatomy, the hospital was looking for a solution that could also be personalised for each of its patients and should also provide 100% accuracy with faster recovery time. To which Sunshine Hospitals decided to partner with Stryker to deploy robotics — Mako Robotic-Arm Assisted Surgery, in order to assist the doctors in joint replacement surgeries.
Robotic-arm assisted surgery, approved by the FDA, was deployed in Sunshine Hospitals to reduce the complexity of joint replacement surgery and offer maximum precision in operation with minimum cuts. Alongside, it also provided a 100% accuracy rate in the operations even in the complicated ones.
While explaining the process, Meenakshi Nevatia, Vice President and Managing Director of Stryker India Private Limited said, “Our Mako Robotic Arm-Assisted Surgery System help doctors to provide personalised surgical experience to every patient, based on their conditions, anatomy and diagnosis. The technology helps in creating a 3D model of the infected joint based on patients’ CT scan, which then allows creating a personalised surgical plan even before entering the operation theatre.”
The robot has a flexible arm with a grounded body and allows the doctors to modify their surgery process during the operation, which helps doctors in enhancing their treatment in real-time. “The doctors need to guide the robotic arm via computers without exerting too much pressure,” said Dr Reddy.
Further, it uses a detailed 3D model of the affected area to outline the tentative site and implant boundaries, personalised to each patient, which then is picked up by robotic arm to operate only on the defined area with 100% micro-precision bone cuts “Since the surgical plan is personalised for each joint, it allows in identifying the most precise bone cuts, implant size, implant’s orientation, fit and alignment,” said Nevatia.
Such advancements significantly benefited the outcome of the joint replacement surgery. Doctors of Sunshine Hospitals were now able to conduct more operations in less time, which in turn was profitable for the hospital’s revenue. “Since its installation at our hospital in February, we performed over 100 Mako knee surgeries in just 20 days, and the results have been exceptional,” said Dr Reddy.
Although it was a novel initiative for doctors, the orthopaedic surgeons of the hospital had to undergo training sessions to perform surgeries using the MAKO Robotic-Arm Assisted Surgery. “Before installing the Mako Systems, four of our orthopaedic surgeons underwent rigorous training on Mako technology in Australia and the USA. Stryker ensured that the surgeon gets access to the new technology and training to use the robot to get the best outcomes for patients,” said Dr Reddy. “The training pathway involved classroom and saw-bone training, followed by cadaver lab training. Post successful completion of the learning path, once the surgeon gets certified, and the robot gets installed at the hospital.”
In fact, post the deployment, according to Dr Reddy, the first few surgeries were performed under the guidance of a highly specialised Mako proctor surgeon. “Apart from these, Stryker also ensured that a dedicated Mako Product Specialist is available for all Mako cases at the hospital to oversee the smooth operation of the robot and lend technical assistance to the surgeon if required.”
The robotic arm uses technologies like artificial intelligence, machine learning, 3D virtual modelling, and MRI scanning technology to help doctors and surgeons with a comprehensive operation plan. As a result, patients can avail benefits like micro precision cuts, reduce the chance of infection, less postoperative pain, accurate impact placement, decrease the requirement of painkillers, and quick patients recovery.
Post the deployment; the hospital experienced a 100% reliable result with accurate alignment and balancing of the implant. The robot uses personalised 3D planning for each patient to make 100% precise cuts as per an individual’s anatomy and minimises margin of error during the procedure.
Furthermore, Dr Reddy stated, because of the 3D pre-planning feature and the haptic feature in the advanced robot, it preserves bone and soft tissues and lower blood loss, thereby reducing post-op pain and aiding in faster patient recovery in comparison to conventional surgeries. He said, “This feature doesn’t allow the cutting tool to move outside the planned haptic boundary,” and therefore omits any chance of error.
Witnessing these benefits patients of Sunshine Hospitals started preferring robotics surgery for their joint replacement — hip and knee, over traditional methods. Alongside, with faster recovery, patients are benefited with reduced hospitalisations time post-operation, which, in turn, made room for the hospital to attend more patients and conduct more replacement surgeries.
“Not only the patient experience has turned out to be quite positive in terms of pain reduction and faster recovery, but also the surgeons have praised Mako’s accuracy and precision and described the handling experience as flawless,” concluded Dr Reddy.
