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Robotic-assisted surgery gives new hope, shortened recovery times to Veterans

A VA surgical team is assisted by the CORI Surgical System while treating a Veteran in the operating room at the W.G. (Bill) Hefner Salisbury VA Medical Center in Salisbury, North Carolina, May 1, 2023.
A VA surgical team is assisted by the CORI Surgical System while treating a Veteran in the operating room at the W.G. (Bill) Hefner Salisbury VA Medical Center in Salisbury, North Carolina, May 1, 2023. U.S. Department of Veterans Affairs photo by Luke Thompson.

For many Veterans, pain is often all but a guarantee in life – an unwanted “memento” from long, trying days in uniform.

Years – and oftentimes decades – of military service takes it toll on the human body.

Multiple deployments; the weight of personal weapons and munitions; one-hundred-plus pound rucks; hot body armor; and the rigors of combat stress are regularly experienced by service members, regardless of military branch.

Many of these physical stressors result in injury and related chronic pain – leading to a lifetime of physical therapy, medication management, and intensive inpatient procedures.

But at the VA, providers are finding new ways to mitigate impact to the Veteran – and one of these comes in the form of the common knee or hip replacement, uncommonly administered by a seasoned VA surgeon’s team and their robot.

Dr. James Comadoll, a surgeon with the Salisbury VA Health Care System and an adjunct professor with Atrium Health Wake Forest Baptist, has brought a special robotic-assisted knee and hip arthroplasty procedure to the VA, and with it, historic prognosis for Veterans qualified for the surgery.

Performed with the aid of the CORI Surgical System, this procedure brings a rapid recovery process for Veterans who elect to undergo a total or partial knee or hip surgery – and it has been a game-changer for the Salisbury VA Orthopedics team.

This revolutionary technology offers image-free smart mapping which builds 3D models of the knee in surgery, handheld precision milling, and is the first system for robotic-assisted knee or hip surgery in the U.S. designed with portability in mind to reduce footprint in the operating room, according to the manufacturer.

With the industry-leading advancements in both the operating room and total outpatient recovery time, Comadoll shared it’s now the only way he does hip or knee replacement surgery after using robotic-aided instruments for the past ten years.

“We have a luxury of having the most sophisticated platform currently available. Why it’s valuable is reproducibility,” said Comadoll. “Long-term satisfaction is based on precision of implant placement. Best analogy: if your tires aren’t aligned, they wear unevenly and fast. If your knee is not aligned, it wears unevenly and fast. Robotics … is taking it further because you’re able to see the function of the knee before the operation. It takes the guess work out and allows you to see what the finished product looks like before you start.”

Salisbury VA was one of the first VA health care systems in the nation to implement the third-generation CORI Surgical System, and the early adoption decision by Comadoll and his team has paid dividends to the Veterans, staff, and residents around the W.G. (Bill) Hefner Salisbury VA Medical Center.

“We have second and fourth-year orthopedic residents from Wake Forest come down to work at the VA. As a training module for residents, it’s indispensable. So this is an opportunity to give back not only to our Veterans but also to educate the people that are going to be taking care of me in the future,” Comadoll said.

Dr. Jeffrey Baker, chief of orthopedics at the Salisbury VA Health Care System, remarked that while residents have historically received hands-on training with legacy knee or hip surgery platforms, receiving instruction from Comadoll with exposure to the latest third-generation robotics surgical system may also bring new opportunities to Veteran care throughout the Veterans Health Administration.

“It’s going to open up other avenues from the standpoint of being able to get other VA orthopedists here to train on the device. So hopefully with what we’re able to do here, other people in the [network] will get interested in bringing this to our Veterans,” he said.

Comadoll worked in the private sector for over 30 years before postponing retirement and choosing to come to VA – and it’s easy to see why he championed the CORI equipment specifically with Team Salisbury.

“This is the best joint OR I’ve ever worked in. I have the best OR team I’ve ever worked with. I thought I’d struggle, have an uphill battle because of super high level of volume and a super high level of accountability. And these people meet and exceed that every time I walk in the OR. They come with an attitude of getting it done.”

While Comadoll has only been with the VA for a few years, his short time providing orthopedic care for Veterans has impacted him significantly.

His team’s implementation of the robotic-aided surgery has given new hope to dozens of Veterans who may have otherwise believed they were doomed to a life of discomfort and immobility.

Comadoll takes it personally, and it’s why he’s serving here at the VA in the twilight of his career.

“We provide a service. And that should be the highest quality service they can get. These [Veterans] are allowing you to operate on them. That level of honor is not always blended through the entire OR team. But it seems to be here. If you step up for our Veterans, they truly appreciate it. It’s a wonderful group of people to work with” he said.

Veterans throughout the Salisbury VA’s 21-county catchment area are already seeing the positive outcomes of the CORI procedure.

The surgery team is averaging two to three Veterans per week, with many reporting incredible results just days after discharge.

Douglas Wolfe, a U.S. Air Force Veteran who served in the Vietnam War, recently opted into the CORI procedure at the recommendation of his primary care provider.

Wolfe enlisted in the Air Force in May 1969, where he served as an air freight specialist and earned the rank of staff sergeant before his discharge in February 1973.

“I certainly tried to do the best job I could. We loaded and unloaded and tried to make sure everybody got what they needed to keep us alive,” said Wolfe.

As a teenager, Wolfe sustained an injury in a motorcycle accident which was further aggravated during his military service. This led him to finally opt for knee surgery at 73 years of age.

His surgery was completed last August by the surgery team at Salisbury VA, and just months into recovery, Wolfe is already planning to achieve his lifelong dream of hiking the 2,600-mile Pacific Crest Trail – something enabled by the results provided by Dr. Comadoll, the operating room staff, and the CORI platform.

“I’ve been really, really happy with everything the VA has provided me with. Dr. Comadoll is a pioneer in robotics. That whole staff there – everybody was great. I was very, very happy that I had chosen the VA for my medical. I just hope I can carry a 40-pound pack 2,654 miles.”