Robots part of health team

High-tech systems assist surgeons during complex procedures

Of the 11 robotic-assisted surgical systems in Canada, Alberta has four and one of them, at the Royal Alexandra Hospital in Edmonton, performs the most robotic-assisted surgeries in the country.

In 2009, surgeons at the RAH performed a total of 239 procedures with the help of a da Vinci robotic surgical system.  

The three other robotic systems are: a da Vinci at both the University Hospital in Edmonton and Rockyview Hospital in Calgary, and the neuroArm robot used for neurosurgeons microsurgery at Calgary’s Foothills Hospital.

The robotic surgery program at the RAH has three surgical teams using the device: general surgery, urology and gynecology.

RAH general surgeons have used it to perform Canada’s first robotic gastric bypass and the first robotic abdominoperineal resection for rectal cancer. 

“We’ve used it for the most complex general surgical procedures that we do,” says Dr. Daniel Birch, medical director for the Centre for the Advancement of Minimally Invasive Surgery (CAMIS) at the RAH.  

“The procedures that we have chosen to investigate are those where there is a fair amount of laparoscopic suturing involved or we’re working in a fairly restricted and tight space such as the pelvis,” says Birch.

By far, most of the robotic assisted surgeries at the RAH in 2009 (205 of 239) were to remove the prostate gland in men who have prostate cancer, a procedure called a robotic-assisted laparoscopic radical prostatectomy or RALP. 

The robotic arms are inserted into the patient’s body through small incisions along with a camera which displays magnified, high-definition 3D images onto a screen.

“The robotic arms have seven degrees of freedom of movement compared to your wrist which only has six, so this allows the surgeon the potential to dissect and reconstruct in challenging locations such as the pelvis,” says Dr. Eric Estey, one of three urologists who use the robot at the RAH. 

Robotic-assisted minimally invasive surgery results in less pain and blood loss and faster recoveries for patients.

The RAH and University hospitals in Edmonton have each had a robot since 2007.  They were funded through the Campaign for Prostate Health which included the Stollery Charitable Foundation and a donation by Jack and Esther Ondrack.  The University Hospital’s device is used only for RALP.

Calgary’s Rockyview Hospital has recently installed the 10th da Vinci robot in Canada, which was supported by funds raised at the Rockyview Invitational Golf Tournaments. 

After RAH, the next busiest robotic site in the country is Montreal’s Jewish General Hospital with 213 surgeries (70 of them RALP) and the third busiest site is the Vancouver General Hospital with 165 surgeries (119 RALP).  The figures were provided by da Vinci, the manufacturer of 10 of the 11 robots used in operating rooms in Canada.

The 11th robot is neuroArm at Calgary’s Foothills Hospital, which was developed by neurosurgeon Dr. Garnette Sutherland with support from the Seaman family, Canada Foundation for Innovation, Alberta Advanced Education and Technology and Western Economic Diversification.

The world’s first MRI-compatible, image-guided surgical robot, neuroArm provides less invasive and more accurate brain surgery, allowing neurosurgeons to be accurate within 50 microns (a micron is one-thousandth of a millimeter).

“With robotics, it is possible to see around corners and manipulate in ways that are now not possible,” says Sutherland. NeuroArm has performed five neurosurgeries to date and will continue to be used clinically over the next year.

Estey expects robotic-assisted surgery may eventually become the new standard of care.

“Ten years from now I think most surgery will be done with some form of assisted computerized technology,” he says.  “Our current robotic assistance is just the beginning.”