Duke Health performed the first robotic shoulder surgery with a handheld robot in April 2026. Previously considered too small an operative area for standard robotic surgery platforms, a handheld platform offers maneuverability and precision for reverse and anatomical shoulder arthroplasty.

Preliminary data indicates greater precision in implant placement, improving outcomes and lessening the need for repeat surgery. “Patients seem to have excellent range of motion with minimal pain,” says Duke shoulder orthopaedic surgeon Christopher S. Klifto, MD, who has performed more than 100 of the procedures in just four months.

Early referral gives patients the opportunity to optimize conservative care, including options through the Duke Joint Health Program. “We want to see patients as early as possible when they have shoulder pain,” says Klifto. “Often, we can treat patients nonoperatively. If referring providers think there’s an indication, it’s always helpful for a patient to have imaging, but we’re happy to start that process with patients as well.”

Robotic surgery comes with advantages and challenges. A common challenge is increased operative time, but Klifto notes the difference has been minimal with this platform. “It’s almost neutral,” he adds.

The most common complication for anatomical shoulder arthroplasty is component malpositioning, sometimes called overstuffing. “Objectively, from our imaging, the robot helps to control for malpositioning," says Klifto. Early data showed higher core implant concordance for robotic-assisted shoulder arthroplasty versus non-robotic cases.

Through haptic control, the robot prevents cuts outside the preoperative plan. "We’ve seen a 15 to 20 percent higher rate of adherence to the preoperative plan,” says Klifto. The platform optimizes scapular thoracic motion potential, maximizing postoperative range of motion.

Duke is an innovator in shoulder surgery, Klifto says. “We’ve been developing robotic platforms at Duke for several years,” he adds. “Although this is a new procedure, we have advanced expertise in the field and have thoroughly vetted the device for safety and quality. We’re now teaching other institutions how to use this platform.”

Beyond innovative procedures, Klifto cites the team’s collaborative care as an important differentiator. “Our group discusses complex cases and crafts preoperative plans together, to figure out what’s best for our patients,” he says. Shoulder surgeries can now be performed as outpatient procedures, and Duke ensures patients can access physical and occupational therapy to provide optimal care.

Robotic shoulder surgery is performed with the CORI XT Handheld platform with the CORIOGRAPH software (Smith & Nephew, Watford, England).