St. Michael’s hospital joins robotic
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
“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
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
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