While it might sound like something from a science-fiction movie, robotic surgery is widely considered to be the future of medicine.
British orthopedic surgeon and engineer Dr Jonathan Conroy has delivered over 1,000 robotic-assisted surgeries throughout the UK, and in 2022 he became the first to introduce the state-of-the-art technique in the UAE.
Based at Healthpoint in Abu Dhabi, he brings over 10 years of expertise in robotic hip and knee surgery. Considered one of the world’s leading specialists in his field, he has trained, studied, worked and lectured in Australia, Canada, the UK, the Middle East and across the world.
Bringing a deep and rare knowledge of both medicine and engineering, his extensive academic work is widely acclaimed and he is actively involved in delivering robotics training.
Passionate about helping people live happier and healthier lives through robotic-assisted hip and knee replacement surgeries, or through non-operational options such as weight loss, he is on a mission to prove that robots belong in the operating room.
After all, studies prove that using robots leads to more accurate surgical procedures, better results, and less pain and recovery time for patients.
Following a study by the Dubai Future Foundation that found that 60 percent of recipients wouldn’t consider robot surgery, Dr Conroy spoke to Livehealthy about why the technique is still vastly misunderstood, its many benefits, and all the exciting possibilities it presents.
Where did your interest in robotic-assisted surgery come from?
Interestingly, my decision to go to medical school and become a hip surgeon was inspired by one of my neighbors who I used to deliver newspapers to. He was a surgeon and he took me to watch a hip replacement operation. Right there I decided that was what I wanted to do.
During my training I did a part-time Masters degree in engineering, and my interest in implant design and robotics evolved from there.
Engineering was always something that intrigued me and I think that when you’re really interested in something, you tend to excel in it.
All my skills come together during surgery.
To create the best outcomes, you have to be personable and caring with the patients, but also be aware of the technologies that are involved. I think it’s important for doctors to understand why things are designed the way they are and how they work.
Is robotic surgery becoming more commonplace?
Yes, I’ve worked on almost 1,000 cases in the UK, the third highest of any surgeon in the country.
When I first started, it was quite a new piece of technology, but now it’s more established and there are centers all over the world.
It’s really taking off because we have data and evidence to prove that it works and that it’s safe.
But it’s still important to make sure people understand that it isn’t actually the robot that does the surgery. The robot helps the surgeon, but the surgeon is constantly supervising it and most of the operation is still done by the team. Patients don’t have to worry. It is definitely a safe procedure.
What is the advantage of using a robot?
The main advantage is their accuracy and precision.
Before we do the operation, we do a 3D CT scan of the hip or knee and this lets us perform the operation virtually beforehand. We can work out the exact size of the implant, and where we’re going to place it. If there’s any abnormalities in the bone we can see them really clearly, which isn’t possible on X-rays. This means that we’re not surprised by anything on the day of the surgery itself.
For instance, when I do an operation for a knee replacement, we already have the various implant sizes ready because we know exactly what we’re going to do.
Robots also help us to cut the bone more accurately.
Sometimes, if the bone is soft, the blade can cut in an unusual position or it can move or be knocked, and so it becomes very inaccurate. But the robot is consistent to about 0.5 millimeter in its cuts, and it’s got the ability to do them in three dimensions. The human eye is not quite as accurate, so using robots reduces the risk of soft tissue trauma.
It removes human error too?
Most knee or hip replacements are successful. Studies show that more than 90 percent of patients are happy with the results, and just five percent are dissatisfied because something went slightly wrong.
The robot reduces errors because it helps the surgeon double-check what they’re doing. For example, if I get to a stage in the operation and the robot says it’s all going well and we should do X or Y, and I agree with that, it’s really reassuring. Whereas, if the surgeon doesn’t have technology to double-check against, they’re more likely to make mistakes.
After all, surgeons are only human. We could be tired, it might be a busy day, or we could be coming to the end of a shift and feeling less sharp than we were at the start. In these cases the robots give us a second opinion and some help.
How will robotics develop?
There’s no doubt that these machines are going to improve in the future. The AI aspect of it is something that’s quite interesting because the future robotic systems will be able to work out what movements the surgeons are going to make, how long they take with each task, and how it can do certain steps automatically.
We’re getting closer to the stage where we can have a robotic system doing the whole operation. This would reduce the chances of infection dramatically. Infections only happen when other humans are in the operating room, and without them everything could be kept very clean. That would be one great advantage.
However, most patients trust their doctor and want them to be there in case something goes wrong with the machine. So I think patients would take some persuading to be comfortable with not having a doctor present.
It’s similar to how we have pilots on planes when we don’t really need them. I think a few more generations need to pass before robots can do surgeries independently.
Why do you think the majority of people in Dubai wouldn’t consider robotic surgery?
I’m quite interested in that. For instance, only today I had a patient who said that they didn’t want robotic surgery. But, when I explained the procedure to them and told them that most of the procedure is done by the surgeon, they changed their mind.
I think if there was more education about what the robot does and what the surgeon does, more people would choose the robotic system. Personally, if I was having an operation, I’d want it to be robotic. I recommend them to all my patients too because it’s so much safer. We have to get that message out there.
Is it more precise?
Yes. The robot has something called haptics. This means it senses when it’s cutting the bone or not. It won’t allow the surgeon to make cuts in the wrong place. For example, if you’re using a saw for a knee replacement, as soon as it comes to the end of the bone the machine cuts out.
But, when you’re doing it by hand, quite often the surgeon will move it just a few millimeters through the bone and into the soft tissues. This can create bleeding, pain, and swelling. Robotics therefore leads to quicker recovery and less pain.
How long does it take to recover from surgeries like that?
Everybody is different. If you’re young, fit and active, you will recover quicker than an older patient who’s had the disease for a long period of time.
In my practice, I consistently see patients that recover quicker than they used to. Hip replacements used to require six weeks on crutches, but I’ve had patients coming back after one to two weeks saying that they don’t need crutches anymore.
I’ve also had knee replacement patients go home the same day or the following day after operations that would normally cause them to be kept in for three to four days. They also become pain-free after three or four weeks, rather than the usual eight or nine.
It’s quite hard to quantify because of the different variables, but overall robotics seems to improve recovery time.
Are some medical professionals against using robotics?
Absolutely. We had a lot of resistance when I started using them in the UK. I was the first to use the Mako robot in replacement surgeries, and some of my colleagues were very skeptical about it and thought it could go wrong.
But as an engineer and as an academic, you have to go with what the evidence says works.
During my training, I designed many of the implants I use in the United States using a robot. The doctors over there encouraged me to stick with robotics despite what my colleagues were saying.
I came to realize that the older surgeons who already had big practices, didn’t want to retrain and study something new.
But it’s now very common for new surgeons to study robotics. It’s normal for people to be anxious and wary of change, but if we embrace technology and you do it in a safe way, we can create a better future.
For example, you wouldn’t want your car built by hand. You would expect it to be built by a robot because they’re more accurate. I don’t think we should be ashamed to say that technology does a better job than a surgeon.
Is the medical profession particularly resistant to new technologies?
Traditionally, doctors like to make their own decisions and they’re cautious and hard to sway.
The investment involved also puts people off because new technologies normally cost more money. Healthcare is very expensive and it’s got to be justified with the insurance companies. There’s a lot of paperwork involved.
Amongst patients some are very cautious about new treatments, but others just want the latest thing.
Ultimately, new technology has to prove itself as a cost-effective option, but also be introduced in a safe way. That means that it takes a little bit longer than if we were introducing a new technology to the manufacturing industry. We’ve got to prove that it’s safe first
What can we do to look after our hips and knees?
If you look at the reasons for hip or knee arthritis, it’s often genetic.
Unfortunately, some people have a higher risk of having arthritis due to the shape of their joints, for instance if their hip joint is more egg-shaped rather than round.
Other people develop arthritis because of a traumatic event such as a road traffic accident, a fall or a sporting injury.
Some patients worry that too much exercise might cause arthritis, but there’s no real evidence of this. If anything, eating healthy, keeping fit and participating in exercise should give your joints better longevity.
If you have arthritis and you exercise regularly each day, even if it’s just walking the dog or going out for a cycle, you can put off having a hip or knee replacement for longer. Gentle activity is very good for your joints.
Can obesity cause joint problems?
If you’re a heavy person, the extra weight that’s being put on your joints can lead to a lot of pain. So, there’s no doubt that losing weight will help with this. We see this so often. Patients come in wanting a knee replacement, but if we manage to encourage them to lose weight, the pain eases by itself. Extra weight has a big effect on your whole body, including your heart and vessels.
It is really important to keep healthy and look after yourself. If you don’t, you will suffer the consequences in your joints when you’re older.
Is it difficult to broach the subject of losing weight?
It’s up to each individual to decide how much they eat or what their weight is.
I think that most patients who are overweight are aware that they need to lose weight, but they find it very difficult to do so.
So, as a doctor you have to be sensitive about it. You don’t know the reasons behind why people are overweight.
Our job is simply to explain the benefits of losing weight, and the fact that being overweight leads to a higher chance of health complications. We have a duty to get that across without offending the patient.
Smoking is another factor that can increase the risk of problems with wound healing and anaesthetics.
In some cases, these operations won’t be funded unless the patient has made an effort to lose weight or give up smoking.
Is inactivity bad for your joints?
Our joints are able to function because of the muscles around them. So, if you’re fit and active, the muscles around your joints are strong and protective. But, if you’re sedentary, those muscles aren’t quite as strong and you’re more likely to have an injury.
Do you recommend resistance training?
Yes. But most people don’t have to do loads of exercise. You don’t have to be in the gym every day.
You just need to maintain a decent step count a relatively balanced diet. That doesn’t mean that you have to eat healthy every day, we’re all allowed some cheat days.
But, if you can do simple things like bike to work rather than drive, it really makes a difference to how you feel.
What would you say to someone who is nervous about robotic surgery?
I would say that it’s normal to be nervous about any kind of surgery.
You can research the technical side of it online, and read about the experiences of other patients. Some have returned to playing sport or exercising, and gone on to do tremendous things. You can see what it actually involves on YouTube as well. It’s not as scary as you might think.
But the best thing to do is go and chat to a surgeon or a doctor that you trust. Most surgeons have a good knowledge of robotic surgery now.
You can also ask around amongst your friends. After all, most of us know someone who’s had a hip or knee replacement.
For more information about the surgery options at Healthpoint Hospital Abu Dhabi, visit healthpoint.ae.