Hackensack University Medical Center First in New Jersey to Adopt TMINI Robotic Surgery System

Next generation, handheld robot allows traditional surgery approaches and workflows and supports open platform implant options for total knee replacement

An early adopter of the TMINI miniature robotic system from Think Surgical, Inc., Hackensack University Medical Center’s Yair Kissin, M.D., will soon complete the institution’s 25th total knee replacement with the wireless, handheld system—which will then open the institution to train other orthopedic surgeons in the next-generation robotic surgery technology.

Unlike its much larger predecessors, the TMINI resembles the traditional handheld power drill instrumentation, but offers greater accuracy due to pre-procedure planning and in-surgery positioning guidance. Hackensack University Medical Center was an FDA trial site for the TMINI and is now the first hospital in New Jersey and the greater New York metropolitan area to bring the technology to clinical practice.

Dr. Kissin observes that the TMINI takes some of the adoption hurdles plaguing earlier generation robotic systems, namely reducing the large size, allowing instrumentation and processes similar to traditional surgical approaches.

“What this allows is for the surgeon to do a total knee replacement in a fairly traditional way, except with the technology of the bigger robots—the previous robot generation. It now makes it more streamlined in a handheld wireless device, so it's really not that disruptive to the workflow,” Dr. Kissin said.

Another advantage: The TMINI is an open platform system, unlike the larger robotic systems tied to proprietary implants. This allows a wider selection of implants to now be inserted robotically, and lets surgeons select the best implant fit for an individual patient.

“That is particularly important with knees versus other joints, to have that flexibility.” Dr. Kissin said. “Knees by far outnumber the other joints, so just by sheer volume, and then also their own nuances and far greater different philosophies on how to do a knee correctly, kinematically and mechanically.”

The pre-surgical rather than intra-procedure patient CAT-scan imaging and planning process also ensures proper-sized implant selection based on actual anatomic parameters in advance of the procedure, rather than during, which supports better inventory management. Once the knee is opened, pre-operative and intra-operative imaging are corroborated, and the surgical team fine-tunes adjustments as the patient's knee moves.

“That's pretty much the holy grail, that you have a pre-op plan that is fairly accurate with the ability still to fine-tune it,” Dr. Kissin said.

The TMINI also typically allows shorter procedure times than predecessor robotic systems, which can avail robotic TKA to patients previously ineligible, such as elderly individuals or those with cardiac conditions. In the first cases he’s performed with the TMINI, Dr. Kissin said knee alignment and balance measured well post-op and patients have experienced quick recoveries. He is hopeful revision rates will be lower as patients are tracked long term.

The TMINI marks the next step in the evolution of robotic surgery, eliminating the larger size of predecessor systems—generations that Hackensack University Medical Center also helped launch into field-wide practice as a robotic surgery center of excellence and clinical trial site. The center plans to offer in-person and live-streamed educational demonstrations of the TMINI to surgeons and residents.

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