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Experts forecast future of surgical robotics at Discovery conference

By Jerry Zeidenberg

TORONTO – The day will come when robots will perform prostatectomies, liver and kidney surgeries and more, with better results than living and breathing surgeons, says Dr. Christopher Schlacta, director of CSTAR at London Health Sciences and a leading authority on surgical robotics.

“Will robots become better surgeons than us?” he asked. “I’m sure that will happen.

Dr. Schlacta participated in a discussion about surgical robotics and tele-surgery at the OCE Discovery Conference, held at the Metro Toronto Convention Centre in May. The gathering was combination conference and trade show for start-ups and technological innovators, sponsored by the government of Ontario.

For his part, Dr. Schlacta conducted the first single-port robotic surgery in Canada, when in 2013 he removed the gall bladder of a patient through one tiny hole in the belly button. Traditionally, robotic surgery requires four incisions for the catheters carrying instruments, lights and cameras.

He explained that a ‘perfect surgery’ could conceivably be monitored and recorded by cameras and sensors, and the data could be uploaded to a computer-driven surgical robot. The machine would then be able to repeat the optimal surgery pretty much on its own, time after time.

With a robot, quipped Dr. Schlacta, “You’re never getting a surgeon with a hangover or with marriage problems.”

However, one of Dr. Schlacta’s interlocutors strongly disagreed. Dr. Mehran Anvari asserted that a robot can often be of tremendous help, but will never perform as well as the best surgeons. “Robots won’t remove the need for surgeons,” he said, “just as calculators didn’t eliminate accountants and bookkeepers.”

Instead, he said, robots can improve the performance of an unskilled or inexperienced surgeon. “We know that in every hospital, there are good and not so good surgeons. And if it’s my daughter who needs an operation, we know who to go to and who to avoid.”

Dr. Anvari is a professor of surgery at McMaster University, and CEO of the Centre for Surgical Invention and Innovation, in Hamilton.

“A surgical robot can turn a poor performer into a high-level performer,” he added.

Dr. Anvari has been working with surgical robots for the past 25 years. His centre is developing its own medical robots, including the Image Guided Automated Robot (IGAR), a device that works in conjunction with an MRI scanner to help surgeons conduct more accurate breast cancer operations. It is currently in trials and awaiting regulatory approvals in the United States. Some $30 million has been invested in IGAR.

He also conducted the world’s first complete tele-surgery, in 2003, when he performed surgery on a patient in North Bay while in Hamilton, 400 kilometers away.

Tele-surgery can also benefit from robotics, he said, as human surgeons have difficulty adjusting to latency – the delays in images that are transmitted over telecommunication lines – while computers and robots can easily make the necessary adjustments.

While robotics and tele-surgery can deliver top-tier medical skills to remote regions that are often without the services of an experienced surgeon, most rural and isolated areas haven’t benefited, as the technology is expensive.

Surgical robots like Intuitive Surgical’s da Vinci, the leading system on the market today, require multi-million dollar investments in equipment and specialized training.

Governments and health regions across Canada have been loath to make these investments when pressed 12 different ways for funding for nurses, long-term care, home care and other needs, not to mention deteriorating buildings.

Still, the prices of surgical robots are on the verge of falling, while the technology becomes even more adept.

Toronto-based Titan Medical has been developing a surgical robot that will sell for only $800,000 – less than half the cost of a da Vinci system. It will also provide the surgeon with unsurpassed flexibility while conducting operations, due to the invention of a new, snake-like technology that enables a single entry point while carrying all of the cameras and high dexterity instruments that are needed.

The SPORT robot enables ‘single port’ surgeries, meaning that only one small incision needs to be made. Titan’s founders believe it is a major improvement over other systems on the market, as it offers much better flexibility and superior imaging.

“We developed a very flexible arm, with seven plus one degrees of freedom,” said Dr. Reiza Rayman, president of Titan Medical. Moreover, the single port system carries not one but two cameras for extra-precise imaging.

“This 3-D view allows for more accurate surgeries,” said Dr. Rayman, explaining that poor imaging in other systems has led to less than ideal outcomes in some cases.

Prototypes of Titan’s SPORT robot will soon be available, and testing on humans is expected to begin in 2016. The system is scheduled to be commercially available by mid-2017.

Not only is the device less expensive than other surgical robots, but it will also have a smaller footprint, allowing it to be moved from one OR to another or to ambulatory settings.

All three speakers agreed that major technological changes and cost reductions will have a huge impact on the medical sector, with surgical robots entering the operating room like never before.

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