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Digital event “The Clinica San Francesco of Verona celebrates ten years of Mako robot activity”

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The Clinica San Francesco of Verona, the capital of robotic surgery.

On Tuesday 31st August 2021 was held the digital event “The Clinica San Francesco of Verona celebrates ten years of Mako robot activity”, sponsored by the Verona’s Medical Association and the Università degli Studi of Verona, and organized on the occasion of the tenth anniversary of the first prosthetic orthopaedic surgery operation with the Mako system performed in Italy by Dr Piergiuseppe Perazzini, director of Orthopaedic and Traumatology Functional Unit.

The online meeting was attended by the major Italian and American experts of robotic orthopaedic surgery and the organizations that today have a decisive role for the sector international community, explaining their own experience, the most advanced innovations, benefits and future prospects. The high-technology robotic platform for the Mako prosthetic surgery was developed in the USA by the firm Stryker and introduced to Italy in 2011 by AB Medica; currently the Mako robotic systems installed worldwide are more than 1000, of which 30 in Italy (one of the first European countries for number of robotic platforms installed).

Thanks to the specific planning carried out for every patient on the CAT scan and the haptic technology that allows to remove only the necessary bone tissue, the Mako system permits to achieve a precision in the prothesis placing which was not achievable before by traditional surgery. On a total of over 450.000 surgeries performed until today (31st August 2021) worldwide with Mako robotic procedure, in Italy and Europe the primacy belongs to Dr Perazzini who since 2011 has performed with his team 2759 total and partial knee replacements and 1215 hip replacements with Mako robot, creating – in 2013 – the European Robotic Orthopaedic Centre (CORE – Centro di Ortopedia Robotica Europeo), an European reference robotic surgery school inside the Clinica San Francesco.

“Dr Perazzini and his team are reference point for the training of our professionals in this procedure. Our organizational model patient-centered requires us to assure a high quality of services and constant and consistent investments in most advanced technologies and state-of-the-art instrumentation” Maria Laura Garofalo, Garofalo Health Care’s CEO declared.

According to Robert C. Cohen – guest of the event – President of Digital, Robotics and Enabling Technology of Stryker firm, in the next few years the trend will be to assure a “continuum of care”. The technology is planning and developing in this direction creating real digital ecosystems, where the patient and surgeon are in constant contact through apps able to follow all phases – pre, intra and post-operative.

CLINICA SAN FRANCESCO IS A NEW ITALIAN HAND SURGERY SOCIETY CENTRE

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The Clinica San Francesco, thanks to the great job carried out by orthopaedic surgeons, specialized in hand and elbow surgery, MD Alberto Donadelli, Enrico Carità and Mara Laterza, received an important recognition. The Clinic has become Reference Centre for the Italian Hand Surgery Society (SICM).

“We are proud of this goal – MD Donadelli explains -. Together with MD Carità and Laterza we worked and studied hard. There are few facilities that can enter into activity criteria, we will be able to join the Italian and European Hand Surgery Society initiatives in surgical and educational field”.

To know the SICM history click here https://www.sicm.it/

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Doctors Donadelli and Carità at the CMC Science Evidence Symposium of Geneva

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The Clinica San Francesco always at the front line in the international sharing of its own surgical experience.

The orthopaedic surgeons of Hand and Elbow Unit, Alberto Donadelli and Enrico Carità, have recently attended the 2021 CMC Science Evidence SYMPOSIUM, held on Friday 2 and Saturday 3 July in Geneva, Switzerland.

During the event that drew the leading international experts of sector, the specialists of the Clinic explained – discussing with European colleagues – their own experience as forerunners of wrist ligament reconstruction and rhizoarthrosis prosthesis implant with the help of augmented reality (3D), performed for the first time in Italy on March 2021 with MD Mara Laterza.

The Clinica San Francesco has recently been recognized as Reference Centre of the Italian Hand Surgery Society (SICM).

THE TITANIUM PROSTHESIS AND ROBOT UPGRADE ALLOW STABLE AND HIGH-PERFORMANCE HIP IMPLANTS

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Titanium prostheses realized with a 3D procedure, this is the latest great news of the Clinica San Francesco.

It’s about titanium acetabular components ‘customized’ (tailored on the basis of 3D CAT scan) that ensure a greater joint stability and so a lower risk of dislocation after implant. The 3D production technology allows to obtain a porous surface, projected to imitate the complex features of bone and foster a long-term biological fixation.

Another great news ‘joins’ the titanium prosthesis, that is the software upgrade of robot that helps the surgeon in hip replacement. MD Piergiuseppe Perazzini, pioneer of robotic orthopaedic surgery, first to introduce it to Italy now is the first surgeon to use the Mako robot upgrade 4.0.

The upgraded robotic system allows an immediate “personalization” in the prosthetic operation, with significant advantages for the patient thanks to the assessment of parameters absolutely unknown or not assessable in traditional prosthetic surgery, as, for example, the “Pelvic Tilt”, the change of pelvis position, and so of prosthetic implant, moving from sitting to upright position; or the “Range of Virtual Motion”, that is the virtual simulation of femoral prosthetic component movement during the operation. An upgrade that permits to increase the stability of prosthesis which restores the useful parameters to reconstruct a perfect joint structure, reducing considerably the implant revision operations.

INNOVATION AND EXPERTISE: THE HAND SURGERY TEAM TEACHES IN ITALY

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A state of the art prosthesis, biarticulated, very similar to the used ones for hips able to offer outstanding benefits in rhizoarthrosis treatment (thumb artrosis), used for the first time in Italy by the Hand Surgery Team of the Clinica San Francesco that confirms its innovative and pioneering character.

The Hand an Elbow Surgery team, directed by MD Alberto Donadelli, was the first in Italy to use this kind of prosthesis: “After following several courses abroad we imported to Italy a great expertise and achieved a huge success of outcomes on treated patients – MD Donadelli comments -. Right away we observed a strong clinical and functional improvement of thumb and an immediate recovery of mobility and so daily and work activities“.

Not just innovation, but the Clinica San Francesco and its surgical staff continue to teach through training activity in operating room. MD Donadelli together with MD Enrico Carità are nationally recognized as trainers of this procedure that makes Clinica San Francesco once again cutting-edge.

Indeed, recently, the MD Donadelli’s staff hosted in operating room MD Massimo Massarella, hand surgeon of Villa Stuart Clinic in Rome who attended to the implant of these state-of-the-art trapeze-metacarpal prostheses, defined “Touch”.

TEN YEARS OF ROBOTIC PROSTHETIC SURGERY: THE CLINICA SAN FRANCESCO IS THE ONLY ONE IN EUROPE TO CROSS THIS FINISHING LINE

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Ten years of experience with robotic prosthetic surgery. MD Piergiuseppe Perazzini today is the most experienced European surgeon using the robot in operating room.

The Clinica San Francesco celebrates an important goal: ten years of state of the art. It was 2010 when orthopaedic surgeon MD Piergiuseppe Perazzini, Director of the Orthopaedic and Traumatology Unit, after a journey in Florida (USA) and a training in some American hospitals, decided to import this procedure to Europe.

In January 2011 the Clinica San Francesco performed the first robotic prosthetic operation outside the USA. “I became aware of this new robotic system able to solve some problems that we orthopaedic surgeons encounter during knee and hip replacements – Mr. Perazzini explains -. These problems are related to painful prostheses, a not complete functional recovery or patients’ general dissatisfaction”.

The prosthetic surgery allows a greater precision in placement of implant thanks to a system able to repeat perfectly what the surgeon planned based on preoperative CT scan. The simulation on created virtual model allows surgeon to have a picture of anatomy and possible difficulties that could encounter before the patient goes into operating room.

The precision of surgical gesture using the robot ensures a not-invasive surgery. Not invasive means the respect and preservation of tissues, ligaments and bones that allow the patient a quicker recovery, so, to start immediately the rehabilitation. Last aspect, no less important, is the safety of patient. The robotic system works in a defined and controlled field so that it avoids to damage parts not subject to operation and protects the tissues of patient by possible damages.

Today, the Clinica San Francesco is accredited with the Italian National Health Service and holds the highest number of total and partial knee and hip replacements with robot all over the Europe. The performed operations are more then 4.000. The Veneto Regional Government with its deliberation of 14th May 2019 recognized the Clinica San Francesco as “Regional reference centre for the robotic orthopaedic surgery”.

In the past ten years the Clinica San Francesco has become a reference point for surgeons from all over Europe who wish to use the robot in operating room.

MD Perazzini operates patients from across Italy, trains Italian and European orthopaedic surgeons by courses, skill lab, lectures and training directly in operating room. In these years Mr. Perazzini trained over a hundred surgeons on the use of robot.

FIRST OPERATION IN ITALY ON WRIST AND RHIZOARTHROSIS WITH AUGMENTED REALITY

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The Hand Surgery Team has reconstructed the ligament of a wrist and implanted a prosthesis for rhizoartrosis with the help of augmented reality. By 3D viewers, the surgeons could visualize the operating field and useful information on patient, sharing them with colleagues from all over Italy.

First operations of wrist and hand surgery with augmented reality at the Clinica San Francesco to confirm the pioneering spirit of the facility. A new technology – until now used mainly in some sector as air force – that uses a 3D viewer to show, next to real elements, also essential virtual objects to give more information on the patient and lead the surgeon during operation.

The orthopaedic surgeons, specialized in hand surgery, MD Enrico Carità, Alberto Donadelli and Mara Laterza, on Tuesday 9th March 2021 entered into operating room with gloves, scalpels, masks and 3D viewers. Both operations were performed with the collaboration of MD Pier Paolo Borelli and remote assistance of 4Solid, the software developer of this technology. During the first operation an important wrist ligament, damaged after a trauma, was reconstructed. During the second one, instead, was treated a rhizoarthrosis implanting a state-of-the-art trapeze-metacarpal prosthesis, that represents a particularly specialized element of the Clinic.

“The use of augmented reality allows to increase the precision of the surgical gesture – MD Carità explains – visualizing in parallel with the operating field the instrumental tests of patient, technical notes and preoperative planning especially during the replacement. Thanks to the augmented reality it was possible to carry out the operation visualizing in operating field all the instrumental tests and preoperative planning of patients in the form of holograms. All this live: indeed several Italian surgeons were connected and could attend and interact with us”

An innovative system that finds its great utility in sharing the surgical act, in the possibility to show new procedures and help possibly the colleagues during the operation.

“The connected colleagues could comment, ask, express opinions during the most critical steps – MD Carità and Donadelli conclude -. This new technology will allow to break down the distances, putting national and international specialists in touch and sharing technical, surgical and rehabilitative information. It will be also able to be used for the training helping remotely who wants to carry out operations particularly difficult or needs technical support”.

THE RISK MANAGER IS IMPORTANT FOR PATIENT SAFETY

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The aim of Risk Manager is to make the hospital a place still safer for the patient, that means to reduce as much as possible the probability of error in clinical and care field.

MD Lorena Zanini is responsible for the risk management.

What are the objectives of the risk management policy?

 ● Enhance the quality of care in order to reduce the risks related to the therapeutic diagnostic process and therefore offer more guarantees of safety to patient.

 ●  Protect the image of facility.

 ●  Protect who carries out his/her own activity within the facility.

When the clinical risk management is optimal?

A management of clinical risk is optimal when ensures:

– An effective communication at different operational levels: is fundamental the communication among workers, especially in the phases of passage and admission of patient between the different care teams.

– The spread of safety culture within the organization and of non-technical knowledges and skills among all workers so that they behave safely.

– The safety of environments and contexts, integrating in the organizational model the different roles that manage the maintenance, the course for the drugs, the devices, biological samples, food, sterilization of materials, wastes, patient transport, and management of internal and external health emergencies.

– The standardization of care processes intended as identification of patient, repeat of important/critical information, prevention of falls and decubitus lesions, hand washing, control of hospital infections, pain management, health emergencies. Integration of clinical-care courses, application of the ministerial recommendations.

– The management of adverse event or avoided event intended as immediate and medium-term aspects, means of communication towards patients and their families, associations for the protection of users and media, support to involved workers and patients and their families.

– Learning by experience (reactive and proactive analysis, survey on safety culture, assessment among peers on safety).

H2M2H – THE ROBOT PROTAGONIST IN REHABILITATION

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At the Clinica San Francesco the robotics is protagonist not just in operating room, but it is inserted in the rehabilitation course, before and after the knee and hip replacement operation.

The clinic staff, composed by orthopaedic surgeons and physiotherapists, directed by orthopaedic surgeon and director of Orthopaedics and Traumatology Unit, MD Piergiuseppe Perazzini, developed an intensive rehabilitation protocol that, thanks to the use of robotic platform combined with the robotic prosthetic surgery, ensures the recovery of activities in record time and qualitatively better.

Hunova, this is the name of the robotic platform, is characterized by:

•          A total modulation of operating parameters

•          An easy re-programmability of exercises without changing physically the platform

•          An objective assessment of patient’s state by data acquisition (pre, during and post-intensive rehabilitation).

Thanks to the platform the personnel is able to personalize the rehabilitation treatment.

The protocol realized is called ““H2M2H”, an acronym that means “Hunova to Mako to Hunova” and consists in an initial assessment, before operation, both clinical and robotic, of postoperative intensive rehabilitation under the system of admission (about 10-14 days) during which the patient uses daily the platform together with the traditional rehabilitation, a clinical assessment before discahrge and, finally, a robotic assessment of follow-up 3 months since operation. The protocol “H2M2H” is dedicated to the patients who undergo the robotic total and partial knee and hip replacement by Mako robot.

The protocol “H2M2H” was born by a study that compared the effectiveness of rehabilitation course by platform with a traditional course on patients who underwent the total knee replacement operation. So a database was created where the resulting data from two types of course had been inserted. The data, once compared, revealed that the patients treated with robotic rehabilitation at the moment of follow-up after 3 months achieved better outcomes.

The training carried out with Hunova platform, during the intensive rehabilitation phase after knee replacement, has positive effects on the balance, maintenance of upright position and two functional and fundamental movements in activities of daily life: sitting down and standing (assessed with the robotic) and during the walk.

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Mako System Certification Surgical Training Program Verona 1-2 December 2020

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Despite the complicated period due to the Covid19 pandemic the Clinica San Francesco ends the 2020 as protagonist in robotic surgery training.

The MD, Piergiuseppe Perazzini (Director) and Paolo Sembenini, members of the Orthopaedics and Traumatology Functional Unit participated as speakers and faculty in the “Mako System Certification Surgical Training Program – Mako Total Knee & Partial Knee & Total Hip applications”, the certification course for robotic orthopaedic surgery held at the ICLO Teaching and Research Center of Verona (Italy) on Tuesday 1st and Wednesday 2nd December 2020. The training event was conducted by the Clinica San Francesco’s staff and represents now a recurring fixed reference point in the national orthopaedic landscape, aimed at surgeons from Italy who want to learn the robotic procedure.

The Perazzini’s staff represents the real European pioneer and outside the USA for the robotic prosthetic surgery, having introduced it in 2011 for the unicompartmental knee and in 2012 for the total hip (as well as being the first in Italy in 2017 for the total knee), having the widest and longest case history.