---
title: 'Accelus Robot Demonstration and Q&A'
type: 'lesson'
url: 'https://doc.social/courses/awake-spine-hybrid-course/ultrasound-and-regional-block-demonstrations'
course: 'Awake Spine Hybrid Course'
course_url: 'https://doc.social/courses/awake-spine-hybrid-course'
position: '14 of 15'
author: 'Alok Sharan, MD MHCDS'
transcript: 'yes'
---

# Accelus Robot Demonstration and Q&A

## Summary

_This lesson is a recording without a written summary._

## Transcript

2,875 words · 17 min · 7 speakers · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:09] Speaker 1: We're, so we, uh, we're really fortunate that Exelis brought in their uh robotic system. So just hold on to your glasses and everyone who's on uh Zoom. We're gonna bring, shift the screen now over to the robot and Doctor Ernest Braxton is gonna do a demonstration of the Exelis robot.
[0:26] Speaker 2: So, uh, I'm gonna
[0:27] Speaker 2: I wanna start with a little overview of the robotic system that we have here at Vail, Vail. And this is just kind of an overview setup of how it works. So, um, it's a table-mounted camera. And what that means is, um, that as you move the patient, you don't have to adjust the, the camera. Um, with the Other systems of the Northern digital systems with the Wally Ey.
[0:52] Speaker 2: Um, I'm always telling my assistants, hey, you know, the game's on, you're blocking the, you're blocking the camera. Uh, my assistants and people are getting in the view of this. By having it table mounted, it makes it a little bit easier. So once you get the, um, the, uh, creating, once you create your sterile barrier, you'd start with image acquisition. So the, the, the way the image acquisition works.
[1:11] Speaker 2: Currently, it's with an OR, I think in 2022, uh um in Q3, there's gonna be uh uh um um compatibility with a 3D acquisition system like a Zim or or a GE or uh a loop. And then I think in 2023, Q1 of 2023, I, I'd start looking forward to like 2D floral uh for your, your image your data set for image acquisition.
[1:40] Speaker 2: So
[1:41] Speaker 2: Once you get the registration done, you don't, you no longer need um the OR and and um.
[1:49] Speaker 2: The OR in the, in the field, and you can start uh planning and getting uh and and start with pedicle screw placement. So, while that's running, I'm gonna start and show the folks how to, how do you, how do you actually plan this, the system. And it's actually pretty really intuitive. Um, you select what screw you're gonna put in. I'll do left L4. I'll alter the screw to the, you know, where I want it. You, you wanna look for the, you wanna be in the saddle.
[2:16] Speaker 2: After you store your, after you have the um the right screw, you store your plan, then you do the next screw, and it's really easy. I just kind of flip it over and then pull it
[2:29] Speaker 2: back
[2:33] Speaker 2: maybe adjust the angle a little bit.
[2:39] Speaker 2: OK, then store your plan, and let's say we're gonna do L5, so we'll do L5.
[2:44] Speaker 2: Come down here.
[2:47] Speaker 2: Over here.
[2:49] Speaker 2: And, you know, right in the saddle, I think that's a good spot for my L5 screw.
[2:57] Speaker 2: Uh, store your plan, the right side.
[3:01] Speaker 2: Come over
[3:04] Speaker 2: And this is how you can, you know, plan out all your screw trajectories. Uh, so plan. Once you have the, uh, the plan stored.
[3:18] Speaker 2: You can go to navigate. So.
[3:21] Speaker 2: The way the, the arm works, if you, if you, first you start by releasing the, the ratchet arm, we're in, we're in developing, we're developing a, a more mechanical one to make it a little bit easier. But for now, it's a, uh, it's, it's this move, and you just move the screw.
[3:37] Speaker 2: To
[3:39] Speaker 2: You know, the ballpark of where he needs to go, and you can see this is your target, and you want to just be in range of the target.
[3:52] Speaker 2: So,
[3:53] Speaker 2: Move it over, you're in reach.
[4:00] Speaker 2: And then, and then the, then you kind of fine, fine tune and fine program your, your target. And then, in this way, it is, it is a navigated drill guide, but it allows for more reproducible um events. And then you may wanna start.
[4:16] Speaker 2: I don't know how, I mean, how you all do it. I like to use a an all, there will be an option for a um.
[4:25] Speaker 2: Uh,
[4:28] Speaker 2: For power for a drill.
[4:32] Speaker 2: Yeah.
[4:43] Speaker 2: Yeah.
[4:49] Speaker 2: And then we're, you know, off to the races. That's um.
[4:54] Speaker 2: Some folks like a really rigid, um,
[4:58] Speaker 2: System, I prefer to have a little bit of feel to it, a little bit of give to it.
[5:05] Speaker 2: Make your all
[5:08] Speaker 3: Yep.
[5:12] Speaker 2: And then
[5:15] Speaker 3: Then you wanna put in your,
[5:19] Speaker 2: your, your pedicle skirt. So we've decreased the footprint.
[5:29] Speaker 2: In, in your OR we've come up with a solution that's more economical, especially for the ASC environment. Uh, we, we also have Other robots, but for the ASC this is what we're gonna be using and that, I mean, that, that, that's, that's really the, the bulk of it. It's, it's just kind of a next generation smaller form factor way to navigate pedicle screws, um.
[5:55] Speaker 2: I think that um the improvements with 2 with 2D is gonna make this really accessible to ASCs around the country. Um, that's gonna be huge.
[6:07] Speaker 4: Hi, Ernest.
[6:09] Speaker 4: Hey, uh, when you're planning those screws virtually, uh, do you have the ability to see your, because I, I saw you basically just drug that same screw to the Other pedicle. Are you able to see your Other, your Other plans? Are you able to kind of virtually see all the screws that you planned on the screen at once?
[6:27] Speaker 5: Does that make sense?
[6:28] Speaker 2: Uh huh. And the next, in the next update, in the next update, but that, that would be helpful just because you don't wanna have, I mean, a screw this way, this way, and that way, uh, and getting the rod to kind of marry up with that. And the next update, will, but the, the way, uh, I, I use it is I make, I kind of plan the incision I wanna use and for, it's either 4 centimeters off midline, 4.5 centimeters off midline, and, or 5 centimeters off midline. I don't go more than 5, and it's kind of small, medium, large.
[6:57] Speaker 2: And one of the tricks, I think, to percutaneous or navigated Surgery.
[7:02] Speaker 2: is to dissect out the tissue plane between the multivitous and the long disthmus. And I just use my finger. I use my finger and I drag it across the transverse processes. And so, no matter what we do, if we're aiming for that saddle, I've kind of exposed that and I'm gonna have the um device go through that same incision. So, it's 23 centimeter incisions, either 4 centimeters off midline, if they're small, 4.5 or 5, and those are the, just the three levels. And then I'll also um
[7:30] Speaker 2: Do a tube, uh, drop a tube in, usually an 18 millimeter tube to do my partial facetectomy and get to the disc and put the inner body in. That's, that's, that's what my workflow is. But in the next software update, you'll be able to do more planning, especially in a revision. Now, we're not doing revisions in our ASC. We're, we're, uh, it's all about Patient Selection, uh, appropriate Patient Selection for who you wanna do in your ASC.
[7:56] Speaker 2: But like if you do have a revision, you want to plan the rod and and kind of get more sophisticated, I think that will be available in the next update.
[8:03] Speaker 2: Answer your question.
[8:06] Speaker 4: Very good, thank you.
[8:08] Speaker 2: How are, how are things in Texas, Grant?
[8:10] Speaker 2: You're, you're in Texas,
[8:12] Speaker 4: I am, yeah, I'm in Fort Worth
[8:13] Speaker 2: now. Yeah, excellent. I remember
[8:15] Speaker 4: working. Everything's good.
[8:16] Speaker 2: You have a big experience with um Doctor Vardaman, right? Didn't you work with, uh, yeah,
[8:20] Speaker 4: yeah, I did a fellowship year with him and did a ton of robot cases and then when I moved to Fort Worth, I, I've got access to two robots here, so, yeah. Still running with that pretty, pretty
[8:32] Speaker 4: strong.
[8:32] Speaker 2: I actually came out to visit you all when I first started getting interested in robots, and I think that was like 2018 or
[8:38] Speaker 2: Maybe 2017 I came out.
[8:40] Speaker 4: That was
[8:41] Speaker 4: when I was still doing my fellowship with him.
[8:42] Speaker 2: Yeah. Excellent, man.
[8:45] Speaker 2: Well, nice, nice having you out there.
[8:47] Speaker 4: Absolutely.
[8:50] Speaker 2: Are you using the emerging glasses out there, or are you just watching that on your computer?
[8:54] Speaker 4: No, I've got the glasses.
[8:58] Speaker 4: It's pretty,
[8:58] Speaker 2: it's
[8:58] Speaker 4: pretty crazy.
[8:59] Speaker 2: It's pretty crazy.
[9:01] Speaker 2: Um, any Other questions out there before we go to our next year? I think, um, he's already got, kinda got the the next one lined up. And again, this is designed to be a smaller form factor. It's designed to be in the future, portable. This is something that you could put in the back of your car, and may, and instead of using this tower, this tower is just, um, there's not nothing to it. You could potentially take a laptop, take it to your Other AC or your Other place. If you're going, if you're in Fort Worth, oftentimes you're in multiple different, different hospitals. And, um,
[9:31] Speaker 2: It, it's conceivable that, you know, at this price point, it's something that you could afford to have yourself and lease it to your Surgery center. Um, I would check with the individual compliance of, of the process of doing that, but, um,
[9:44] Speaker 2: That could be a potential use of this smaller device.
[9:49] Speaker 5: Right, so that's a, I have a question. Yeah, I guess really more directed at as well is along the same kind of lines, uh, is there gonna be a peruse kind of program as opposed to buying the entire
[10:04] Speaker 2: setup. Do, do you wanna take that? Uh, that sounds like more like a Business question.
[10:10] Speaker 2: I'll give you, uh, I'll give you this.
[10:13] Speaker 6: Hi, yes, there will be, um, a per lease, and there's different types of financing solutions. you don't have to purchase it outright, so there is Other options. This is Lisa Jacobs. She's a VP of sales, yes.
[10:27] Speaker 5: Hi Lisa. Hi. I remember you.
[10:30] Speaker 2: Oh
[10:32] Speaker 4: It's not creepy at all.
[10:34] Speaker 2: No, I'm just kidding. We're, we're, we're standing here talking to a monitor, uh, and these eyes, so, and so you can see us, but we can't see you. Oh, well,
[10:44] Speaker 5: no, I, I actually had the opportunity to meet Lisa when uh I went down and visited the solos facility. So I've had a chance to actually play hands-on.
[10:54] Speaker 2: OK, excellent.
[10:55] Speaker 5: It's a great place.
[10:57] Speaker 2: Um, there's, there's, it's a pretty, um, simple setup to set it up and break it down. So we kind of did this and accomplished this in a pretty short period of time. Um, any Other questions? We wanna show him anything else?
[11:11] Speaker 3: The one thing, I mean, at least good to add it if something were to ever wrong with any robotic system, what we're able to do.
[11:19] Speaker 3: Within this system here.
[11:22] Speaker 3: I track the screw, right? You see it on the screen, but not only that.
[11:29] Speaker 3: Now we're turning this into
[11:32] Speaker 3: Freehand.
[11:34] Speaker 3: Yeah,
[11:35] Speaker 2: so now you have a navigation solution at a pretty low cost, uh, right in your Surgery center capture camera.
[11:42] Speaker 5: Have a big
[11:44] Speaker 3: you have.
[11:45] Speaker 3: Yeah, and I mean just like you mentioned too with with the northern digital it's 20 degree field of view, it's 120 degree, which is why we're so we get close
[11:53] Speaker 2: to the field and you're not you're less likely to block the camera. I'm always having that problem with the move the camera around, move the light around.
[12:00] Speaker 2: My, uh, my assistant's in the way or scrub tech's in the way, and I'm just, I'm trying to get the screw in there, and they're trying, they're trying to stay ahead of me to do the next step, get the next screw ready, but they often block, block the view.
[12:11] Speaker 3: So, but they were social distancing,
[12:15] Speaker 2: yeah, yeah, they were just social distancing before it was cool.
[12:18] Speaker 7: Yeah, that's what I was asking for my headset actually. I was wondering was it freehanded or you're gonna get tactile feedback. So it sounds like it's all of it. You can go down the line like you would with anything else, feedback and like you were saying, you like a little gift and you want to feel like you're in bone or you want to lose.
[12:36] Speaker 7: Feedback that we get. So it's kind of like best of both worlds a kind of, but it's also setting you up so you don't, you're not looking for a pilot or hole or whatever else I'm currently doing. Uh-huh that tissue trauma of what you're finding. Yeah,
[12:52] Speaker 2: it, it is. And I mean, I, I, I think to your point.
[12:55] Speaker 2: The robot doesn't know the difference between a big mistake and a small mistake. Surgeons do. I know that a medial bre breach is gonna be a bigger deal than a lateral breach. And having a little bit of give and feel, to feel the cortices, I think it, it, it's something that I still like. I'm not really ready to give that up, you know. Um, I don't know if you saw my talk earlier.
[13:16] Speaker 2: But with another, with, on another platform or another system, I always feel, I'm just like crossing my arms, waiting for that thing to kinda engage. This is a more um engaged um situ feeling, but you have the benefits of NAA. And, and if we're, if we're, if we're really getting down to it, why did I get the robot, it's really for radiation exposure.
[13:38] Speaker 2: Uh, these glasses, uh, are new. I didn't have these last time I saw Grant out there. But when they, when they're doing my eye exam, they saw that I have early radiation-induced cataracts. And that was a wake-up call that radiation's real. It's, it's bad, it's bad for surgeons, and it's not, it's not so good for your patients.
[13:54] Speaker 2: Neither, but we're doing this day in and day out. And in a busy practice, we do about 400 cases a year out in Vail. That's a lot of floral exposure. So if I can minimize that in any way by getting NAA in the Surgery center, where we, where we don't have NAA and doing it at a much lower price point, um,
[14:11] Speaker 2: It's, it's, it's around 300 to 4000. I think it's like 350K, but I would talk to Lisa about that. Um, it's, it's, am I, am I close? OK, OK. You know, because when you're looking at a robot, it's really a million dollar investment, unless you're doing the earnout to, to, um, and, and then you, and then you're kind of locked in with, with one company. So, it's a million-dollar investment plus you need your image acquisition system, it can be kind of costly.
[14:40] Speaker 4: So this is the cervical
[14:41] Speaker 4: platform you can, sorry, go ahead, Michael.
[14:46] Speaker 2: So to stay on label, it's, it's for lumbar only. Um, uh, it's, it would be off-label in its current form to use in the cervical space, but not, um, but I do see that coming along in the future. Cervical has got some different, um.
[15:00] Speaker 2: It's a little bit different than the lumbar Spine that it moves a lot more. And so, there, there are some things that need to be worked out before you, we, we can say it's safe to be used in the cervical Spine. Um, but to be on label, it's for lumbar.
[15:15] Speaker 4: So is this truly open platform, you can use any navigated screw or how, what, what is the, what is the process for
[15:22] Speaker 4: that?
[15:23] Speaker 2: Well, I mean, the, the, the, the, the only screw that you can navigate is gonna be line cider through them. And obviously, they want it, but I do think in the future, it can be just in the same way that, you know, when stealth first came out, it was only for um for Legacy and Celera and Voyager. Um, and then.
[15:41] Speaker 2: And as, as things progress, you know, you know, I, I can put in any, any pedicle screw with our stealth system in the hospital, and, but it is designed the, um, to, to, you know, in order to navigate the screw, you, you gotta use their system. Is that right? OK. You see the CAD model on the drawing.
[16:02] Speaker 2: Not to say that in the future, it, it couldn't be worked worked around. Um, but I, I think it's for, for a small company of this size, it's important for them to, to continue to, um,
[16:13] Speaker 2: Uh, have a way to insert their screws, but I, I see, I, I see it as the company grows and develops that it could become agnostic. Um, but I, I, that, that'd be a Business decision for Excelis, not for my, my clinical, you know, not from a clinical standpoint.
[16:30] Speaker 2: Thank you. Yeah.
[16:35] Speaker 2: That's a good question though. It's a good question.
[16:40] Speaker 2: Well, guys, uh, I've taken up enough of your Saturday, uh, morning. This, this video is gonna be memorialized and be available on Docs Social. If you haven't created an account, and I would, uh, highly recommend that you do that so you can check this out at a later date. Um, but, and I wanna, uh, thank all the sponsors from Pacera to Immertech, to, uh, Exelis, um, and, uh, for making this event possible.

## In this course

- [Previous: How to Market your Awake Spine Surgery Program](https://doc.social/llms/courses/awake-spine-hybrid-course/how-to-market-your-awake-spine-surgery-program.md)
- [Next: Ultrasound and Regional Block Demonstrations](https://doc.social/llms/courses/awake-spine-hybrid-course/ultrasound-and-regional-block-demonstrations-2.md)
- [All lessons: Awake Spine Hybrid Course](https://doc.social/llms/courses/awake-spine-hybrid-course.md)