Invited panellist at ICSES 2026: the future of shoulder surgery, and the problem of adoption.

The congress and the panel.

ICSES is the international congress of shoulder and elbow surgery. It was first held in London in 1980, meets every three years and moves between continents. The 2026 congress in Vancouver brought together more than 2,000 specialists from more than 60 countries.¹²

On the final afternoon the program turned to The Future of Shoulder Surgery, an education session in two parts: robotics, navigation and immersive reality first, then artificial intelligence.³

I was invited onto the first, my first international panel. The moderator was Robert Tashjian, chief of shoulder and elbow surgery at the University of Utah.⁴ The other panellists were Patrick Connor of OrthoCarolina in Charlotte, head team physician to the Carolina Panthers for two decades;⁵ Thomas Duquin of the University at Buffalo, whose unit was among the first in the world to use a different robotic shoulder platform;⁶ Natascha Kraus-Spieckermann of University Medicine Greifswald in Germany;⁷ and Quin Throckmorton, who heads shoulder arthroplasty at the Campbell Clinic in Memphis.⁸

The artificial intelligence symposium that followed was moderated by Frederick Matsen of the University of Washington, co-editor of The Shoulder, the reference text many of us trained from,⁹ with Francesco Franceschi (Italy), Ruth Delaney (Ireland), Joaquin Sanchez-Sotelo (United States) and Quin Throckmorton on the panel.³

To stand on stage with a group like that was incredibly humbling, and an honour.

The real subject was adoption.

The symposium title lists three technologies. They do one job: each carries a plan made from a CT scan into the bone.

• Navigation tracks the instruments against the patient's anatomy and shows the surgeon, on a screen, where the hand is relative to the plan.
• Robotics goes a step further and limits where the hand can go. With the Mako shoulder platform I use, the robotic arm keeps the burr inside the planned volume of bone.
• Immersive (mixed) reality puts the plan in the surgeon's line of sight through a headset, overlaid on the operative field.

Because all three are getting good at that job, the conversation moved quickly from the technology to its adoption: who has taken it up, what it has cost them, and whether the rest of the profession should follow.

A discussion like that divides, usefully, into two kinds of surgeon. There are the early users, who took the technology up when the evidence was thin and have now had time to reflect on what it cost and what it gave back. And there are the sceptics, who have watched us do it and are not yet persuaded.

What the sceptics ask.

The sceptics' questions are the right ones.

• Cost. Who pays for the robot and its disposables, and for what measurable gain?
• The learning curve. Who carries it, if not the patients in the early cases?
• Evidence. Does a more accurate implant position make a better shoulder, or only a tidier X-ray?
• Training. What happens to a generation of surgeons who learn the operation with a machine holding the line for them?
• Access. Does the technology widen the gap between the hospitals that can afford it and the ones that cannot?

None of these is answered by enthusiasm.

What early users can now answer.

Some of it can be answered with numbers, because some of us counted. In my first fifty robotic shoulder replacements the robotic step settled at about eight minutes. The operative-time learning curve was largely over by about case 23, and by about case 43 the robotic operation took no longer than my conventional one.¹⁰ The time cost is real, but it is front-loaded and it ends. The full account is here.

What early users got wrong.

We expected the machine to be the hard part. It was the team: the setup, the sequence, the handovers. Adoption turned out to be a training and theatre-process problem, which means it is solved, or not solved, one hospital at a time, and not only in the large academic centres. Our numbers came from a regional private hospital on the Sunshine Coast. The surgeons and hospitals now taking this up across the Asia-Pacific need less persuasion than honest information: how many cases, where the time goes, and what to expect in the first year.

What nobody can answer yet.

I cannot tell you that a robotic shoulder is a better shoulder at ten years. Nobody can. Robotic assistance is intended to make implant position match the plan more reproducibly, and the early data supports that. Whether more reproducible position translates into better function, or into implants that last longer, is not yet established in the shoulder. Accuracy to a plan is not an outcome, and the sceptics are right to keep saying so. That answer will come from years of registry follow-up and from units that publish their own results, including the unflattering ones.

What each side owes the other.

Enthusiasm without data is marketing. Scepticism without data is also just an opinion. The sceptics set the questions. The early users are the only people in a position to answer them, and we owe those answers in counted cases.

Thanks.

My thanks to the congress co-chairs, George Athwal, Graham King, William Levine and Joaquin Sanchez-Sotelo, for the invitation; to Robert Tashjian for moderating; and to my fellow panellists for the conversation.

Frequently asked questions.

What is ICSES?

ICSES is the International Congress on Shoulder and Elbow Surgery, the specialty's international congress. It has been held every three years since the first meeting in London in 1980 and moves between continents. The 16th congress was held at the Vancouver Convention Centre in Canada from 22 to 25 September 2026, hosted by American Shoulder and Elbow Surgeons (ASES), and brought together more than 2,000 specialists from more than 60 countries.

How often is ICSES held, and has it been held in Australia?

ICSES is held every three years. It was last held in Australia in Sydney in 1998. The most recent congresses were in Buenos Aires in 2019, Rome in 2023 and Vancouver in 2026.

What was Dr Joe Coory's role at ICSES 2026?

Dr Joe Coory was an invited panellist, at the invitation of the congress co-chairs. He sat on Symposium 1, "Robotics, Navigation, and Immersive Reality", in education session ES53, "The Future of Shoulder Surgery", on Friday 25 September 2026. He was the only panellist in that session from the Asia-Pacific region.

Who else was on the panel?

The symposium was moderated by Robert Tashjian of the University of Utah. The other panellists were Patrick Connor (OrthoCarolina, United States), Thomas Duquin (University at Buffalo, United States), Natascha Kraus-Spieckermann (University Medicine Greifswald, Germany) and Thomas (Quin) Throckmorton (Campbell Clinic, United States). The session was co-moderated by Frederick Matsen of the University of Washington.

What is the difference between navigation, robotics and mixed reality in shoulder replacement?

All three help a surgeon carry out a plan made from a CT scan. Navigation tracks the instruments and shows on a screen where they are relative to the plan. Robotics uses a robotic arm to limit the cutting tool to the planned area of bone. Mixed reality shows the plan through a headset, overlaid on the surgeon's view of the operation. None of them decides whether an operation is needed.

Does robotic assistance improve the result of a shoulder replacement?

Robotic assistance is intended to make the implant position match the surgeon's plan more reproducibly, and early studies support that. Whether this leads to better shoulder function or longer-lasting implants is not yet established and will take years of follow-up to answer. Results after any shoulder replacement vary from person to person.

What are the main barriers to adopting robotic shoulder replacement?

The barriers surgeons most often raise are cost (the robot and its single-use instruments), longer operating time while a surgeon and team learn the system, the lack of long-term evidence that more accurate implant position improves function or implant survival, and unequal access between hospitals. In Dr Coory's own series, which is submitted for publication and not yet peer reviewed, the extra operating time had resolved by about case 43.

Is robotic shoulder replacement available on the Sunshine Coast?

Yes. Dr Coory has performed Mako robotic-assisted reverse total shoulder replacement on the Sunshine Coast since August 2025, at Buderim Private Hospital and, from October 2026, at Maroochy Private Hospital, for selected patients who need a reverse shoulder replacement.

References.

1. ICSES 2026. 16th International Congress on Shoulder and Elbow Surgery, Vancouver, 22 to 25 September 2026. Hosted by American Shoulder and Elbow Surgeons. icses2026.org
2. Japan Shoulder Society. Looking back on 50 years of international exchange (history and host cities of the international congress since 1980). Read the history
3. ICSES 2026 Scientific Program. Session ES53, The Future of Shoulder Surgery. View the session
4. University of Utah Health. Robert Z. Tashjian, MD. Profile
5. OrthoCarolina. Patrick M. Connor, MD. Profile
6. UBMD Orthopaedics & Sports Medicine. UBMD becomes 3rd site in the world to perform a robotic shoulder arthroplasty. 15 July 2024. Read the report
7. Universitätsmedizin Greifswald. PD Dr med. habil. Natascha Kraus-Spieckermann. Profile
8. San Diego Shoulder Institute. Thomas "Quin" Throckmorton, MD. Profile
9. University of Washington, Department of Orthopaedic Surgery and Sports Medicine. Frederick A. Matsen III, MD. Profile
10. Coory J, et al. Learning curve analysis of the first 50 robotic-assisted reverse total shoulder replacements. Manuscript submitted for publication, 2026. Not yet peer reviewed.

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Related reading on this site

• The first Mako 4 robotic shoulder replacement in Australia
• One hundred robotic shoulder replacements, and what the learning curve actually showed
• How a CT scan becomes a shoulder replacement: inside Mako planning
• Three takeaways from the Stryker Shoulder Arthroplasty Masters Meeting, Sydney 2026
• Mako robotic-assisted reverse total shoulder replacement (procedure detail)