‘A Form of A Robotic Microscope’: Idaho Physician Uses Exoscope To Perform Surgeries On Patients
Treva Lind – April 9, 2020 – The Spokesman-Review Link
By the time Paul Huling needed surgery last fall, he couldn’t use his left arm. Huling first noticed a problem a few weeks before when he woke up with what felt like a stiff, sore neck.
Soon, pain and tingling progressed. It started extending from his neck into his shoulder, then spreading down the limb. The discomfort became so intense, he couldn’t sleep.
“One day I woke up with a stiff neck, and it just felt like I slept on it wrong,” said Huling, 53, who lives in Osburn, Idaho. “By the weekend, I was in the ER and getting injections for pain.
“By the time I had surgery, I couldn’t use my left arm at all. It kept getting progressively worse.”
After initial visits in October at Inland Northwest Spine & Neurosurgery in Coeur d’Alene, Dr. Doug Blaty knew surgery wasn’t just an option, it was a necessity for Huling.
“He had a disc herniation and very bad arthritis pressing on nerves – all this was causing his weakness, numbness and pain, and it was progressing,” Blaty said. “It was situated at the C4-5 level about the middle of the neck.”
Huling’s condition required a delicate procedure, though, working in an area of the spine where nerve damage or other issues could occur. But with the help of a new robotic tool called an exoscope, Blaty performed the spine surgery fusion in November while also removing arthritis pressing on nerves.
“There are a lot of important structures; you have to watch out for nerves and the spinal cord,” said Blaty, who said Huling’s surgery involved a two-level fusion. The exoscope is “a form of a robotic microscope.”
Blaty, who performs surgeries at Northwest Specialty Hospital in Post Falls, believes he’s one of a few Northwest surgeons using the technology made by Synaptive. The device, creating high-resolution images, is mounted on a robotic arm tracking a surgeon’s instruments while staying out of the way.
Using the exoscope since early fall, he estimates it has supported him in as many as 40 procedures.
“It’s an exoscope because it is a microscope, but it blows up images for you at high definition, so instead of your eyes being stuck into a microscope during surgery, it’s blown up onto a 55-inch television screen.
“You can stand up tall and move your body around as you need to. The imaging is much better.
“Because it’s not a big, bulky microscope – it’s kind of a tube that comes down – you can position it in all sorts of angles, but you don’t personally have to be at that angle. I can get into an extreme angle, and I can still see the image to operate on the patient looking at the screen.”
He sees it as safer for patients, too.
“It definitely allows me to get at angles I usually can’t get at with a traditional microscope,” he said.
“Also, it has robotic guidance where you can place tools in different positions, and it can follow based on where your tool is, so it creates more accurate movements in order to see down lines of sight and so I can turn my body into appropriate positions.”
For Huling, the surgeon needed to decompress the nerves being pinched. Over time, bone overgrowth — bone spurs, bulging discs and hardened bone – can cause narrowing of the space for the nerves and spinal cord.
Removing such arthritis is a general term, Blaty said, but he literally removed some of those elements. “You have to be delicate obviously because you have the spinal cord, spinal nerves and arteries,” he added.
That requires a physician being able to lean and turn the body in odd positions. It’s safer if the surgeon can do that with a better ergonomic position and hands closer to the body to prevent slips, he said.
It’s a long surgery, requiring about three hours, with a small incision in front of the neck to get to that spinal area. A titanium plate was used to fuse two discs.
Blaty said when he first examined Huling before the surgery, he was concerned for several reasons. He requested an imaging test called a CT myelogram with contrast to help with diagnosis.
“The most noticeable thing was he had such profound weakness with his shoulder motions and also had weakness with his bicep, too,” Blaty added. “He also had the numbness all the way down to the thumb side of his hand. He couldn’t even get his shirt on, and it was worsening.”
Huling and his girlfriend, Ruth Courtney, said they can’t recall that he had an accident or blow that would have caused the first stiffness. His condition had built up over time, Blaty said.
Huling previously worked as a law enforcement officer in Shoshone County for six years. He also was in the military and has done much hands-on work as a mechanic and outdoors. Currently, he works in roles as a driver, mechanic and machine operator for Shoshone County.
“The best guess is it was a combination of years of hard work, wear and tear and all exasperated by a recent disc herniation,” the surgeon added.
Huling’s surgery was done as an outpatient procedure with a one-night stay but less than 24 hours.
He said as he woke up from the surgery, things were different. Huling could lift his arm right away. The pain was gone. Soon after, he was able to get off all medications.
Although he knew there were risks, Huling said he was confident going into the surgery that it would work, and he didn’t have other options. “We’d already tried shots, and I couldn’t move my arm, so physical therapy wouldn’t work.
“When I first woke up (from surgery), I raised my hand all the way up. It was instantaneous; I could move my arm. I couldn’t do that before. To put on deodorant before, I’d have to lift my arm up against the wall.
“The tingling in my fingers was gone when I woke up. It was amazing. I never had nerve pain before and never want it again.”
Most insurance companies will cover this type of surgery, Blaty said, because it’s common enough. Patient costs might vary based on deductibles.
Huling said he’s back to his usual activity level.
“I went back to work in two weeks on light duty, then, in six weeks, I was back to full time doing my regular job. I was walking, doing my exercises.”