Dr Ayyappan V Nair, Consultant-Shoulder Surgery, Sports Medicine and Arthroscopy, Manipal Hospital talks about the role of technology in keyhole shoulder surgery
The word ‘arthroscope’ was derived from the Greek word ‘skopium’ which means “to look at the joint”. Keyhole surgery (Arthrosopic surgery) is a major advancement in the field of orthopaedic surgery in the last century. Keyhole surgeries are highly beneficial to patients in having short operating time, minimal scar, less invasive and early recovery. Arthroscopic surgery changed the outlook of orthopaedic surgical procedures which were more invasive in the past.
The development of arthroscopy as a major tool in keyhole surgery is credited to Dr Masaki Watanabe, a Japanese surgeon. He was a former student of Professor Kenji Takagi who was the first to perform the first cadaver knee arthroscopy using the arthroscope.
Keyhole surgery has made it possible in diagnosing and treating all shoulder pathologies at present. New shoulder pathologies contributing to shoulder pain and morbidity were identified. Normal anatomical variants such as Bufford complex and Biceps variants were diagnosed with the advent of keyhole surgeries.
The advent of keyhole arthroscopic surgeries warranted orthopaedic surgeons to get trained in a new set of surgical skills to perform these surgeries. The technological advancements enabled the surgeons to train themselves in these advanced skills. Various shoulder simulation models like ‘Alex’ and 3D models helped the doctors in mastering the arthroscopic skills to perform the procedures with ease.
The latest technological advancements in the field of arthroscopic shoulder surgeries include the use of artificial tissue to reduce the morbidity of patients, needle arthroscopy, the use of nanobots in keyhole surgeries, the advent of artificial intelligence and the use of 3D printing.
The ligament repair surgeries performed as keyhole needed tendon grafts and muscle patches for the procedure which added to the patient’s morbidity. This can be prevented by advancements in the field of tissue engineering. The development of artificial tendon and muscle grafts served the purpose with fewer side effects and keyhole surgery will be a tool for introducing these grafts into the joint. One such example is cartilage repair surgeries which can be performed with genetically engineered cartilage tissue.
The advancement in the field of keyhole surgery is not only restricted to tissue engineering, but also in the development of the latest instruments for the surgery. The needle arthroscopy is one among them. The invention of the needle arthroscope enabled surgeons to perform these complex procedures as daycare office surgeries. The needle arthroscope same as the size of a needle can help the patients in knowing the pathologies and getting immediate treatment for the same without pain struck complex investigations.
Nanobots are the future of keyhole surgeries. These technologically engineered robots can be introduced into the joint with a needle. These advanced robots sized less than 100 nanometers can repair the damaged joint structures. Nanobots can patch the damaged joint with a nonreactive biocompatible compound that is strong and flexible. These bots are eliminated from the body once the surgery is completed through the body’s lymph system.
The shoulder replacement surgeries which at present are performed as open surgeries can be done as keyhole surgeries in the future. Arthroscopic polymer resurfacing techniques are on trial and shortly one can expect keyhole shoulder replacement surgeries.
3D printing, the landmark advancement, in the field of shoulder surgeries helped the orthopaedicians immensely in knowing the patient’s anatomy before the procedure. It is also used in preoperative planning of the procedure, constructing patient-specific implants and instrumentation. Shoulder instability surgeries done as keyhole uses 3d printing in establishing and recreating patients’ pathology like the amount of bone loss and also preparing patient-specific implants. This can help the patients in faster recovery with reduced failure rates.
Artificial intelligence, the future of all technologies, can be used in keyhole surgeries of the shoulder. Augmented Reality (AR), Virtual Reality (VR) and Machine Learning (ML) will create a significant leap in the field of medicine. AR and VR enable the surgeon to visualise the patient’s anatomy in virtual dimensions and communicate with other surgeons from all over the globe while performing the procedure. Imagine a surgeon located in the United States can see, assist, mentor and monitor the surgery performed in India by another surgeon with the help of VR. The surgeon who operates wearing the specialised Hololens AR glasses can transmit the 3D anatomy of the patient to the other surgeon from different parts of the world.
Both technological and biological advancements which will be put to use soon can transform the keyhole surgeries of the shoulder to the next level. These advancements will be of great benefit to the common people in getting their problems diagnosed faster and getting a speedy recovery from the disease conditions. The patients will be flying back to their normal activities with the latest advancements in medicine.
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