ROBOTICS A REVOLUTION IN WORLD OF SURGERY.
Dr. Christopher Schlachta is a firm believer that any time you can put a computer between a surgeon and a patient, it’s an opportunity to remove human frailty and error.
As the medical director of CSTAR (Canadian Surgical Technologies & Advanced Robotics) at London Health Sciences Centre, Dr. Schlachta is one of a growing number of surgeons working with robotics systems to conduct minimally invasive surgeries.
The technology that has been a focus of CSTAR’s efforts is the da Vinci Surgical System developed by Intuitive Surgical Inc. It combines 3D HD visualization with precise dexterity and control.
Robotic surgeries are definitely on the rise in Canada. Ten years ago, Dr. Schlachta estimates there were 42 surgeries using the da Vinci system. “We have seen close to a 100-fold increase since then.”
What robots can do is get the surgeon’s hands and eyes inside the patient without the need for major incisions. Microchip advancements bring the eyes that enable surgeons to view inner workings through openings as small as subway tokens. Robotic appendages, for their part, apply highly dexterous hands to do the precision work. With this approach, even complex heart valve and cancer surgeries can be performed through one- to two-centimetre incisions with the surgeon viewing a magnified image on a console.
“The micro scaling is enormously valuable because the surgeon’s hands don’t have to be inside the patient,” Dr. Schlachta says.
Robotics are even being applied to something as delicate and complex as brain surgery. University of Calgary is home to the world’s only NeuroArm, a robotic system that can be used within an MRI (magnetic resonance imaging) machine setting. NeuroArm was conceived by Dr. Garnette Sutherland, professor of neurosurgery, in conjunction with space robotic engineers at MDA (MacDonald, Dettwiler and Associates Ltd.) in Vancouver.
“The technology allows you to recreate the sight, sound and touch for surgery, while allowing you to access very small passageways,” Dr. Sutherland explains. “This changes the paradigm for microsurgery because operations we can perform tend to be more minimalistic using smaller incisions.”
Regardless of the procedure, the benefits in terms of recovery can be significant, Dr.
Nerve damage is lower and lengths of stay are dramatically reduced
Schlachta reports. “While studies are still underway, we do know the surgery is better, nerve damage is lower and lengths of stay are dramatically reduced.” By way of example, a bile duct operation once required an 11-day stay. With the da Vinci, it’s down to four.
Dr. Bob Kiaii, chief of cardiac surgery at LHSC, is one of only four Canadian surgeons who work with the da Vinci system for cardiac procedures. A pioneer in his own right, he has achieved numerous North American and world firsts in robotic surgical techniques. He estimates 85% to 90% of the surgeries he performs today are robotically assisted.
“I believe Canada is on the leading edge of the robotic surgery movement. We are in fact one of the prime users in the field and had some major pioneers.” Notables include Dr. Douglas Boyd, who completed the world’s first closed-chest, beating-heart coronary artery bypass surgery in 1999 using an older technology iteration known as the ZEUS Robotic Surgical System.
Robotic surgery also has become a major focal point for the team at the Ottawa Hospital. It has expanded the approach even further through a standardized workflow process that encompasses multidisciplinary team members.
“It’s all managed and standardized under one [specialty-trained] system team, from nursing to perioperative care,” explains Dr. Michael Fung-Kee-Fung, a gynecological oncologist who helped bring the da Vinci robot to the hospital. “We have one of the fastest-growing robotics programs in Canada because of that.”
Dr. Fung believes robotics represent a new platform that offers infinite opportunities for future innovation. “Because we have a computer between us and the patient, there is the potential to leverage other technologies such as functional imaging to give us more insight into the surgical field.”
And while the debate remains whether robotics is cheaper, the value equation is really about quality, he says. “There’s less pain, less blood loss and less complications with robotic surgery. It can have a huge impact on the patient experience.”
When he’s asked, why robotic surgery, Dr. Schlachta will say this: “Computers do everything highly sensitive, from flying planes to running nuclear plants. It’s about time we learned how to use them when operating on people. They don’t get tired, and they don’t make mistakes.”
It’s not a question of if it will happen, he states. “The days of picking up a scalpel in your hand and operating will soon be history.”