Surgical technologies

St. Michael’s hospital joins robotic revolution

TORONTO – St. Michael’s Hospital, a major teaching hospital in Toronto’s downtown core, has become the city’s first medical centre to acquire a surgical robotic system.

As a result, hospital surgeon Ken Pace now has four arms, instead of two, when working on his patients. What’s more, those arms – and many fingers – can enter the smallest of places through tiny incisions. They are expected to reduce post-op pain for patients, speed up recovery times and reduce the incidence of infection.

The ‘da Vinci’ system has been acquired from the world’s leading producer of medical robots, Intuitive Surgical, at a cost of $4.5 million.

“Everybody recognizes this is the present, or the future, of surgery,” Dr. Pace, a urologist, told the Toronto Star. “There is no question we can do better surgery with this than we can with the traditional laparoscopic approaches and even open surgery. It’s going to push us to the next level, allow us to do better surgery for our patients, and have a better outcome.”

Urologists are the first to use the robot, primarily for prostate cancer surgeries but also for kidney blockages. The robot will also be called on by gynecologists doing hysterectomies, as well as general surgeons.

Cardiac specialists intend to use the robot to replace some types of heart valves.

The robot was designed to push the boundaries of laparoscopic surgery, in which a surgeon operates on a patient using long instruments inserted through “keyhole” incisions in the skin.

The robot’s main advantage is that its arms act like a surgeon’s hands, beyond the scope of a simple tool, says Pace, holding out a traditional laparoscopic instrument to make his point.

“These are long sticks that just open and close,” he says, making the pincers on the end of the instrument snap shut. “They can’t bend, they can’t twist, so they can’t do this,” explained Dr. Pace, who swivels his wrist in rapid circles – “like the hand can.”

The robot’s full range of motion helps surgeons manoeuvre the curved suture needles at tricky angles, and gives them more precision during delicate procedures. The robotic instruments are electro-mechanically enhanced and have what are called “endo-wrists” attached to curved pincers that are roughly one centimetre in size.

Pace says they can do everything a human hand can, surgically speaking.

“It’s almost like you shrunk yourself, dropped inside the patient and are doing the surgery from the inside.”

Technically, the da Vinci device is more a remote-control system than a robot, says Dr. Pace. The surgeon sits at a console, away from the operating table, and manipulates the four robotic arms using joystick controls. The system replicates the surgeon’s movements in real time. “It’s completely under the surgeon’s control, does nothing on its own,” says Dr. Pace.

Three of the robotic arms do surgery while the fourth acts as camera operator and light source. The camera projects a view of the surgical site –- in high-definition –- onto flat-screen TVs arrayed in the OR to guide the surgeon at the console.

Pace says the magnified 3-D vision gives him a better view of fine-detailed surgery than if he was at the patient’s side, especially since the robot filters out tremors and translates a surgeon’s real-time movements into a smaller scale.

London Health Sciences Centre at University of Western Ontario was the first Canadian purchaser of a da Vinci system, in 2003. There are now eight up and running in this country, including two in London.

Dr. Christopher Schlachta, medical director of St. Mike’s CSTAR robotics program, says prostrate patients, in particular, prefer to have robot-assisted surgery, owing to preliminary evidence that its precision better preserves urine control and erectile function, two potential side effects.

Dr. John Honey, head of urology at St. Mike’s, is sold also a proponent of the system. “It makes the operation half as long, with a quicker recovery time – it gets patients home quicker and back to work,” he says.