Over the past decade, the use of robots to assist in surgical procedures has increased significantly. Robotic surgery has become widespread in a wide range of medical specialties, including general surgery, urology, and gynaecology. The use of robots in spine surgery has only recently been explored. Pedicle screw placement is a common procedure in spine surgery, which can be aided using robotic technology. Misplacement of the pedicle screw can result in serious complications such as neurologic or vascular injury, so there is little room for error in this procedure. Drilling with a robotic system requires an accuracy level at least on par with that of currently used screw placement techniques like free-hand drills, fluoroscopy, and computed tomography (CT).

A growing body of research has documented early results demonstrating the robotic systems' equal accuracy and lower radiation exposure when compared with other methods of screw placement.

Related: Robotic surgery gains momentum during COVID-19

According to the World Health Organisation, between 250,000 and 500,000 people worldwide suffer a spinal cord injury each year, often resulting in life-changing loss of sensory and motor function. Up to 90 per cent of these cases are the result of traumatic events. Preliminary Mayo Clinic research indicates that stem cells derived from a patient's own fat can help people with spinal cord injuries improve their motor and sensory function.

Mohamad Bydon, M.D., Mayo clinic

Related: Growing number of patients benefit from robotic-assisted surgery in UAE

In an interview with neurosurgeon clinician-scientist, Mohamad Bydon, M.D., Mayo clinic we spoke about how robotic spine surgery can improve existing methods and research conducted by Mayo Clinic on how using stem cells is a step toward improving motor, sensory function after spinal cord injury.

Dr. Bydon has an interest in studying clinical bioinformatics and serves as Medical Director of the Mayo Clinic Neurosurgical Biobank and Clinical Registry, which compiles prospective data on clinical outcomes of neurosurgical procedures. He also serves as the director of the Mayo Clinic Neuro-Informatics Laboratory, using big data to define the cost and value of medical and surgical interventions.

The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Is this prevalence necessary and needed?

The use of robotics in surgical procedures is rising across surgical specialties. The evidence behind the value of robotics in improving patient care and surgical workflow is well-documented, and the indications of robotic-assisted surgery are expanding. Robotics is not a panacea, but there are several surgical procedures in which a benefit has been proven. In these cases, the rise in robotic-assisted surgery is justified, and it should be further enhanced. The research to improve its applications and expand its indications is also necessary to enhance patient care.

What are the benefits of robotic spine surgery for practitioners and patients? 

The high accuracy and the minimal invasiveness of robotic spine surgery are its two main contributions to patient care. The accuracy offers multiple, well-controlled manipulations. In the case of spine surgery, that means well-placed screws that serve as anchors to the rod, giving stability to the patient. The less invasive nature allows for small surgical wounds, minimal manipulation of the muscles that support the spine, and, therefore, quick return to mobility for the patient and discharge from the hospital.

Robotic systems must provide a degree of accuracy comparable to that of already-established methods of screw placement, can you elaborate on this statement?

In fact, robotic systems aim to improve the degree of accuracy of the already-established surgical methods. Prior to robotic-assisted surgery, most interventions in surgery relied on a combination of imaging and free-hand manipulations. The robotic systems empower contemporary surgical techniques by combining imaging with the precision and reproducibility that the robotic arms offer. Overall, robotic surgery aims to minimize the unavoidable error margin that free-hand manipulations entail.

How does stem cell treatment support patients in recovery for spinal cord injury? What are the next steps in stem cell treatment after spinal cord injury?

Stem cells are the cornerstone of regenerative medicine, and several applications of stem cells are being investigated across a broad spectrum of patient needs. In spinal cord injury, stem cells therapy is hypothesised to influence the intrathecal environment towards a regeneration-permissive state that facilitates the formation of new blood vessels and nerve structures. Outside spinal cord injury, regenerative medicine has demonstrated promising outcomes in dementia and stroke. Nevertheless, all these hypotheses — including spinal cord injury — are still under investigation, and the role of stem cells in clinical practice remains to be determined.

Can you speak about Mayo Clinic’s Case report: Stem cells a step toward improving motor, sensory function after spinal cord injury, what have the findings highlighted?

 This case report presented outcomes of the first patient who was enrolled in our phase 1 clinical trial investigating the role of stem cells in spinal cord injury. The foundations for this clinical trial were laid for years before the publication of these findings via multiple experiments that documented promising results. As in all phase 1 clinical trials, the primary goal of this trial was to demonstrate the safety of the treatment. However, our first patient also responded impressively to the treatment, showing significant improvement in his neurological status. At the moment, a phase 2 clinical trial is being conducted by our team.

Cancer cases are on the rise with 10 million deaths recorded in 2020, according to the World Health Organisation, but focused partnerships between health-centric communities can spark further dialogue, faster care delivery, and play a role in significantly lowering these numbers that in turn could ease the economic burden.

Pfizer Gulf, the regional arm of globally renowned pharmaceutical and biotech corporation, is consciously strengthening its focus on cancer management to drive improved patient outcomes.

“There is a tragic unmet need that really drives our work at Pfizer. One out of eight men, and one out of 11 women die from the disease over the course of their life. In the UAE, we see that breast cancer is the most common type, representing 21.4 per cent of total cancer cases, according to statistics by GLOBOCAN 2020.

“This is a tremendous burden, but also something that is well aligned with our focus area to bring new innovative breakthrough treatments to patients globally and in the Gulf,” said Lindsey Dietschi, Country Manager and Cluster Lead of Pfizer’s emerging markets in the Gulf, which includes the UAE, Bahrain, Kuwait, Oman, Qatar and Yemen.

Establishing a focused cancer community

Pfizer is currently working alongside UAE-based cancer patient societies - Friends of Cancer Patients (FOCP) and Emirates Oncology Society – and lending its expertise to help advance oncology care in the country. As part of its renewed partnership, it aims to encourage early detection and support cancer treatment in the UAE, besides exploring other screening activations.

“Our partnership with the Emirates Oncology Society comprises three components, starting with the areas of increasing scientific exchange, as it is an important factor to drive dialogue that is supportive of patients and new strategic partnerships,” she said.

The second area is to improve clinical decision-making by enabling support for screening services. As an example, Dietschi highlighted a blood test that can detect the BRCA gene mutation in the DNA, which signals the potential increased risk for breast cancer.

“Assisting screening services like that can help us get treatments to patients faster, which is critical in supporting the patient journey. And finally, we want to accelerate local evidence generation, because we know how important furthering that scientific dialogue, while being evidence-based, and how we can pursue and improve patient outcomes,” she added.

Briefly touching on the Friends of Cancer Patients partnership, Pfizer is focused on empowering the patient voice. “We know how important this is in our work to make sure we understand the patient's challenges, so that it can inform the approaches that we take in our innovation and in our collaborations with partners,” Dietschi said.

This is followed by a commitment to enhance the patient journey, from diagnosis and treatment to monitoring outcomes. “The third part is related to improving outcomes, because we know how critical it is to build awareness diagnosis and education, and really supporting the caregivers and loved ones, in addition to the cancer patients themselves,” she added.

Pfizer Gulf will continue to support Pink Caravan activations in the month of October and explore other screening activations to suburbs and villages as well.

Amplifying the prospects of digital transformation

Digital transformation is happening in every aspect of healthcare, Dietschi said, and from Pfizer’s perspective, there are growing opportunities to facilitate better patient outcomes, faster discovery of innovation, and even the simplification of processes to make things easier in its pursuit to deliver breakthroughs to patients.

“Through the lens of oncology, in particular, we have seen some developments in areas such as radiology, where we see a lot of promise with digital transformation. For example, we know the importance of a high-quality image in order to inform a treatment protocol and monitor disease progression, or hopefully, lack of disease progression. Being able to use AI, as an example, to power and improve decision-making to support patients is a growing trend,” she said.

Similarly, pathology has adopted a digital front, enabling analysis through a mobile device or a computer, courtesy of the rise in telehealth. Remote pathologists can now review imagery from any location to support patient diagnosis and monitor outcomes.

“At Pfizer, we see digitalisation as an opportunity to help us deliver on our mission, to innovate and bring breakthroughs to patients, with great urgency. We see it as a chance to make our internal processes the most efficient in order to enhance our potential to deliver solutions faster to patients that really need it. The burden we see in cancer solutions is something tremendous. And so, we feel a great deal of urgency to bring our best scientific expertise forward at the soonest possible stage to support cancer patients with new, life-changing treatments,” she said.

Pfizer has undertaken various strategies to bring treatments forward and make it available across the globe and the UAE. In pursuit of new innovation Dietschi said that Pfizer is expecting up to 13 new approvals of breakthrough treatments by 2025.

“This will continue to be a deliberate focus of the company. This is not limited to the scientific expertise we have already or the medicines we have available, but also applies to the solutions we hope to bring to these countries. We are excited about the possibilities, in our ability to make a difference, to delay the progression of disease, and ultimately, lead to cure,” she concluded.