Mayo Clinic in Florida recently performed its first robot-assisted shoulder arthroplasty, marking the arrival of enhanced, precision orthopedic care for patients in the Southeast and bolstering Mayo Clinic's commitment to advancing models of care across the organization.

Shoulder arthroplasties — also known as shoulder replacements — are reserved for patients with shoulder osteoarthritis whose symptoms are not manageable with nonsurgical treatments such as physical therapy, injections and medications. Shoulder replacements have traditionally been performed using manual instrumentation and surgeon-estimated alignment. While this approach has been effective, it is inherently limited by visual estimation and anatomic variability in patients. 

"What's happened over the past 10 to 15 years in orthopedics is we've started using computer navigation and now robotic assistance," says Dr. Erick Marigi, a Mayo Clinic orthopedic surgeon. "In the hip and the knee, they've been doing robot-assisted replacements for years, but for the shoulder (because it’s a smaller complex joint), it's just been harder to develop, until now."

In manual shoulder replacements, surgeons make an incision and use guides to position implants. Though 3D computer planning has been available and is helpful, execution in the operating room has remained manual.

"We're no longer limited by our eyes and using a guide, which has a few millimeters of variance," says Dr. Marigi. "Now it's one degree of variance and under a millimeter of precision."

Another key advantage of robot-assisted shoulder replacements is improved consistency and reproducibility, particularly in complex cases. The technology simplifies procedures for patients with significant bone wear or other challenges that make conventional techniques difficult, allowing surgeons to achieve more predictable results. 

Long-term efficacy data for robot-assisted shoulder replacements are emerging, but evidence from robot-assisted hip and knee replacements is promising. Cases once considered highly complex can now be approached more like standard procedures.

Innovation and integration

Dr. Marigi says the adoption and integration of robot-assisted surgery is a testament to Mayo Clinic's spirit of bridging innovation into action.

"It is the spirit of Mayo Clinic in general: constantly pushing the envelope and providing solutions that help patients," he says.

Dr. Marigi's mentors, Drs. Joaquin Sanchez-Sotelo and John Sperling, both orthopedic surgeons at Mayo Clinic in Rochester, laid the foundation for robot-assisted orthopedic surgeries across Mayo Clinic. 

"Collaborative efforts have never been better across Mayo Clinic as a healthcare enterprise," says Dr. Sanchez-Sotelo. "The implementation of robot-assisted shoulder arthroplasty across all campuses allows us to offer the same quality care to all our patients, regardless of geography. It also facilitates lines of collaboration for innovation and research across our institution."

Dr. Sperling, who in April 2024 completed the world's first robot-assisted shoulder surgery, says, "Robotic shoulder arthroplasty has the potential to significantly improve our ability to enhance the quality of care for our patients worldwide."

Later that year, Dr. Sanchez-Sotelo also performed a robotic total shoulder replacement. 

"Our new generations will embrace robot-assisted surgery and enjoy iterative processes through which digital enabling technology will only continue to improve," says Dr. Sanchez-Sotelo.

Among that new generation is Dr. Jeff Hassebrock, an orthopedic surgeon at Mayo Clinic in Arizona, who performed the first robot-assisted shoulder replacement in the Southwest, extending the site's leadership in robotic orthopedic surgery. He believes that the intersection of artificial intelligence, preoperative planning and robotic procedural execution will lead to a renaissance in how standard shoulder replacements are performed.

"Mayo Clinic's investments in advanced technologies reflect our commitment to providing innovative, patient-centered care," says Dr. Hassebrock. "Robotics improves the precision and execution of surgical plans that meet the evolving needs of orthopedic care. The era of pre- and postoperative measurement is at hand."

Dr. Marigi believes Mayo Clinic surgeons will continue shepherding this next phase of innovation in orthopedic care. Now, for patients in the Southeast, the technology offers access to innovation closer to home.

"Patients will all have access to this internationally renowned technology locally. That was a big deal for our team," says Dr. Marigi. "I think this is going to be one of our pillars in the future, and the people leading that charge will be Mayo Clinic surgeons."

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