Backs to the Future: Hadassah’s Groundbreaking Robotic Surgery

Dr. Josh Schroeder is a senior surgeon and spine specialist at Hadassah Medical Organization's orthopedic department. His areas of expertise include Pediatric and Adult Spine deformities and Robotic Spine Surgery. Dr. Schroeder performed the world's first two robot surgical repair of a complex spinal break. Born at Hadassah Hospital-Mount Scopus, Dr. Schroeder grew up in Jerusalem, together with his American-born parents and five siblings. He spent 2 years as a Spine Fellow at Weill Cornell Medical College, Department of Orthopedic Surgery in New York City and at The Hospital for Special Surgery, Spine Care Institute also in New York. He also served as an Israel Defense Forces (IDF) officer in joint teams with the Palestinians, in post-Oslo Accord attempts at regional cooperation in the Bethlehem district and now serves as a reserve military doctor in the IDF.

For more about information about Dr. Josh Schroeder

Bedridden Teen Walks Again, Thanks to First-in-Israel Complex Spinal Surgery at Hadassah 
Surgeons Perform World's First-Ever Dual Robotic Surgery at Jerusalem's Hadassah Hospital  
Doctors cure paralyzed 6-year-old
Physician Profile: Dr. Josh Schroeder, Hadassah Medical Center Orthopedic Surgery Resident


Melanie Cole: What a show we have for you today. Our guest performs a two-robot surgical repair of a complex spinal break and in another amazing procedure, a teen can actually walk again thanks to a first in Israel complex spinal surgery at Hadassah. Today, we're speaking with Dr. Josh Schroeder on this episode of Hadassah On Call.

My guest today is Dr. Josh Schroeder. He's a senior surgeon and spine specialist in the orthopedic department of Hadassah Medical Organization in Jerusalem, Israel. You're noted as performing the world's first of its kind dual robotic surgery, a four-hour reconstructive surgery with two robots on Aaron Schwartz who was severely injured when a heavy wall of steel fell on him at work. How did you decide to do this instead of a more standard approach?

Dr. Josh Schroeder, MD: Aaron came to us after the complex spine fracture and a two-ton wall fell and pinned him down. Luckily, he survived, he had a broken tibia and broken multiple vertebrae in the spine. What we usually would do for this kind of surgery is either be an open surgery, which would be mostly four hours and heavy on the blood loss, or a single robot surgery which we do percutaneously, which would be a more advanced surgery. The problem was with so many fractures in the spine, everything would be more around and any kind of pre-op imaging would not be accurate enough in order to allow a safe procedure. What we decided to do is to go and harbor a second robot, which is called the Artis Zeego. It's a robot that is an imaging robot. It allows us very accurate intraoperative imaging, which means once we position the patient in a specific position, the actual location of each one of his broken vertebras will be imaged to us and we'll able to send the second robot, the Mazor, for the accurate location.

The complexity is to a point where you got to know each one of the robots to allow it to work properly. There are great teams at Hadassah supporting and allowing us to use these robots. The second thing is to have the robot talk to each other. It's trying to get a navigation robot to talk to a procedure robot and to get two languages and two different companies, one Israeli company, the Mazor company, to speak to Siemens, which is a German company. It's getting the two technologies to speak in the same interface, that was one of the challenges so we had our teams work on it for quite some time, and when we got that set up, we were able to allow Aaron to have the safest and maybe the most advanced and the most automated kind of surgery that we had to happen.

Melanie: That's amazing. All this complex going back and forth with the languages and getting the robots to talk to each other. How is Aaron doing now?

Dr. Schroeder: He's great. He was out of the hospital a couple days later. He's up walking on his feet. It turned a very complex injury and procedure into a pretty straightforward fancy walk in the park, but a much easier procedure that's safe for him, which allowed him to get out of the hospital and into rehab a few days later.

Melanie: That's incredible. Now tell us a little bit about how you came to perform the spinal surgery of Yusef Rabaya. He's a citizen of the Palestinian Authority and why was this surgery so rare.

Dr. Schroeder: Yusef is a young boy and he was in a very bad car accident in the area Jenin. Several people were killed in the accident and his sister had a bad injury and he was transferred to a small hospital, one of the hospitals in the Palestinian Authority. At that point, he had emergency surgery to stop and control the bleeding, but they noticed that he was paralyzed in both of his legs and the bleeding was coming from the broken spine. What happened was that his spine at the lowest level was disconnected from the rest of the spine, what we called spondylolysis, where one of the vertebrae jumps forward and it completely out of place, which means the spine is pretty much divided at the lowest area segment of the L5-S1 that's totally severed. He couldn't move his legs at all and he was transferred to us. I got a phone call Friday morning from the person in charge of transfers and I said we have an injured child transferring right over from Hadassah. The most complicated cases that people in the Palestinian Authority cannot deal with on their own, they're responsible enough to transfer them to us. We get him at Hadassah, he was sent to the pediatric ICU where the ICU team did a great job stabilizing him over Saturday, which allowed us to plan a surgery in a really small child to allow us to reduce the vertebra that has jumped out of place and allow his nerves to go back into place and to start functioning afterwards. A kid that I thought was going to be wheelchair bound is now up and going. Again, we use the dual robotic technology, which is now become one of our state of art procedures for complex spine injuries and we were able to pinpoint these very fine pedicles, which are probably two to four millimeters in size, and to allow them to bring this terrible injury as part of a team to bring it back to its original anatomical location and allow a stable fixation.

Melanie: One of the things that is so amazing to me is that it seems with you that politics have no effect on your obligation to save human lives, to help people walk again, to help people move their limbs again. Tell us how you came to this feeling.

Dr. Schroeder: I think medicine and politics never take part in Hadassah. For sure, it's one of the things that we stop everything at the door and you can see we have a staff that comes from all over the world – Jewish, Arab, Palestinian, Israeli – now our business is dealing with people and healing people and trying to get people from all around the world better off, and politics has no place to do with medicine. People are people and regardless of their opinions and their personal voice, my job as a doctor is to try and get them better, not get involved in their education. The way I see it is that there's no politics in medicine and I'm happy to deal with any person, anytime with any kind of a conviction.Melanie: Isn't that wonderful? I wish more people felt as you do. Tell us a little bit about your volunteer work and the refugee camps and Uganda.

Dr. Schroeder: I had a great opportunity to go and volunteer several months in a refugee camp. It's always great to perform medicine in a western setting. I trained in New York, I trained in Switzerland and Israeli and I always had the feeling that I would like to try to do something in a totally different setting. I had a great opportunity to go and volunteer in Kampala. There's a refugee camp right next to the capital of Uganda and I spent a couple of months there doing primary health and dealing with the deworming and water sanitation and basic medical care in small villages around the area in Uganda. It was a great experience at a personal level to see how things can be totally different and how the systems work in different stages, and at some places to be the first white person that these people have encountered and to try to bring health to a place that nothing exists over there. That has allowed me to become a doctor and thank God I can go out and do some good in places that people don't have any other person to be there and it's part of the fun of being a doctor.

Melanie: What a great experience for you and for them as well. As we wrap up, tell us a little bit about your work as a military doctor and in the IDF.

Dr. Schroeder: Israeli is always preparing for war and we live in a dangerous neighborhood and we always say let us train forever and never need to use our skills. I'm in charge of military units that is an advanced lifesaving unit, which is deployed in the field in case of a combat situation. Our job is to save as many wounded soldiers as we have. We have a team of doctors and surgeons and about 40-50 medics and paramedics, like a small mash hospital which opens up in the field, and our job is to come and train and do whatever we can in order to save lives, and that's what we do very well. We're definitely trained quite a bit for it and we hope that until we retire, we never need to use these skills in order to save soldiers, but as Israelis and Jewish people, we do not have the privilege of sitting back. We have the obligation to take part and our job is to try to win the war and save as many people whenever we can donate and continue to society.

Melanie: Your mother must be so proud of you. We hear you're going to Ethiopia soon. Tell us a little bit about that.

Dr. Schroeder: Next week. Hadassah has a long-standing relationship with a hospital in northern Ethiopia in a city called Mekelle. It's one of the largest cities in Ethiopia altogether and it has about eight million people in that district. Professor Moses, and Professor Anian microbiology team definitely have a very good relationship and they have been training them with medical students going over there. They came to us with a problem. There are eight million people and there's a lot of deformity going on in these countries, but there are no spine surgeons in Ethiopia. Most of these children have a very bad deformity. They go down to Addis Ababa, but they get transferred over a former teacher of mine to have surgery by Professor Boachi in Ghana. That's a great project, but it doesn't help the children who do not have the facilities to transfer them to Addis Ababa. We go to the hospital and they said please come see if we can have spine surgery by you guys and this is a big surgery, it's not something done by day surgery, but it needs a large facility and ICU teams and the whole process altogether in order to allow us to do it in a safe manner and allow these children who have very deformed spines to have a nice safe procedure with good and stable spines and reduce their mortality by reducing the chances of pneumonia or other kinds of complications associated with such a bad back.

We went down to Ethiopia several months ago, we put a team together and we're going to go down to Ethiopia to do surgery over there. What we've set out to do is a procedure at the same level that we do them at Hadassah. We got Medtronic to donate the instrumentation that we use here, we spoke to the Foreign Ministry of Israeli which kindly transferred everything for us to Ethiopia because it's heavy equipment that we need their help to bring it into the country. Now everything is there and hopefully we'll be flying there Saturday night and starting next week we'll be performing surgeries all next week on these children that have been previously selected by us as cases that we can do over there. Once we're successful on this trip, we'll learn the challenges and we'll perform a future mission in order to continue to work over there. In the long process, we're hoping that we'll be able to bring one of their surgeons to Hadassah for a year or two of training to allow them to be independent that we'll be his mentors from afar and we'll fly in to help him on difficult cases. That way, we're not going to only deal with the problem, but hopefully, train a future generation of Ethiopian surgeons that will be able to deal with the pathologies they encounter.

Melanie: Wow Dr Schroeder, your passion for what you do really comes through and you are such an inspiration to us all. We could sure use more compassionate people such as yourself in this world. Please be sure to come back on and give us some updates. We'd love to hear more of the exceptional work that you are doing on behalf of so many people suffering with spinal injuries. Thank you again for being on with us today. This is Hadassah On Call, New Frontiers in Medicine brought to you by Hadassah, The Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit hadassah.org. To hear more episodes in this podcast series, please visit hadassah.org/podcasts. That's hadassah.org/podcasts. I'm Melanie Cole. Thanks so much for tuning in.

We'd love to know your thoughts, questions, and stories! Send us an email anytime at marketing@hadassah.org.

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