The Challenges of Robotic Surgery

Jonathan Lewin, MD, a spine surgeon and the new chief of robotic spine surgery at Hudson Regional Hospital in Secaucus, NJ and director of spine surgery at North Shore University Hospital in Forest Hills, NY, discusses how the spine field is changing and where the best opportunities are for advancement next year.

How has your role as a spine department leader evolved over the past two to three years? How have your responsibilities changed?

Dr. Jonathan Lewin: I was named department head six to seven months ago. It has taken time away from my clinical practice. Managing hospital responsibilities and the clinical practice can be difficult, with more administrative meetings, discussions, and planning for the future of the program.

What do you consider your No. 1 priority to ensure departmental success?

JL: The field of spinal surgery is changing at a rapid pace. New technology, such as robotics, has had a considerable impact. Additionally, hospitals and surgeons are required to be very cost-conscious when choosing implants, technologies, and devices that are used in surgery. But it’s imperative that we keep the overall mantra of providing what’s best for the patient. The driving theme is to provide what’s best for the patient, but now we’re forced to take into account a cost factor. As it relates to new technology this can be difficult until that technology becomes cost-effective — sometimes it’s not when it first comes out. That’s a decision we need to make as a department.

What is the biggest challenge you are facing as head of the department and how are you overcoming that?

JL: Increasing scrutiny from insurance companies. They are now using a clinical algorithm which allows them to deny coverage, procedures, implants and CPT codes.

What are the department’s goals for 2019 and what is your vision moving forward?

JL: To advance the safety and technology of spine surgery. Figure out what cases need spine surgery and what doesn’t. On the one hand we need to address the anatomic needs of the patient, but on the other hand not overdo it with excessive surgery. For example, we’ve done evaluations with the geriatric population trying to determine whether past procedures could have been treated more conservatively; in some cases, we learn that it could have.

Note: This article appeared in the November 25, 2018 edition of Becker’s Spine. Read the full story here.