Da Vinci, the Robot Proves a Hit in Toronto Hospital

Da Vinci, a $4.5 million robotic system, is proving a sensation in Toronto, Canada.

It is the first advanced surgical system of its kind in the Greater Toronto Area, points out Dr. Ken Pace of the St. Michael’s Hospital.

It performs minimally invasive surgery more quickly and safely. Besides doctors hope patients who get robot-assisted surgery will recover faster and have less post-operative pain and chance of infection.

"Everybody recognizes this is the present, or the future, of surgery," urologist Pace says.

"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, writes Megan Ogilvie in Toronto Star.

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.

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

"These are long sticks that kind of 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" – Pace swivels his wrist in rapid circles – "like the hand can."

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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 electromechanically 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, a creation of California-based Intuitive Surgical, Inc., is more a remote-control system than a robot, says 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 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.

The St. Mike’s robot was put into use for the second time yesterday when Pace and his team performed prostate cancer surgery on a 70-year-old. The first operation, also to remove a cancerous prostate, was done March 20.
As Pace sat working the console controls as head surgeon, the robot’s four arms slowly twisted and turned inside the patient’s inflated abdomen. For four hours, Pace patiently worked the pincers to nip at fat and muscle and get at the walnut-sized prostate.

John Honey, head of urology at St. Mike’s, is sold on 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.

"It’s so easy to use. You could sit (at the controls) and I could give you a suture and you could tie a knot, the first time ...
"If you can tie your laces, you can use this machine."



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