 How
does performing surgery on a patient in Halifax from your
office in Toronto strike you? Like something Isaac Asimov
might have dreamed up? Well it's not the stuff of sci-fi
anymore, thanks to a group of forward-thinking scienceheads
going by the name CSTAR (Canadian Surgical Technologies
and Advanced Robotics).
BY
JOVE, THEY'VE DONE IT
CSTAR is a joint research program of the London Health
Sciences Centre, Lawson Health Research Institute and
the University of Western Ontario. The team has already
put a three-armed robot called Zeus to work performing
remote surgery. Zeus (and telerobots like it) can be
used from great distances and has proven successful
for a number of surgeries, including cardiac and urological.
The technology is still at the
trial stage and it's a few years away from being used
in hospital settings, but experimental use on live patients
has yielded good results. Zeus' first successful telesurgical
effort was performed last year when a urologist in Toronto
and a surgeon 200km away at CSTAR headquarters in London
did a remote pyeloplasty, correcting a blockage in the
ureter of a patient with uteropelvic junction obstruction.
 NUTS
AND BOLTS
Doing telesurgery is a little like playing a video game
with someone out of town. Video capabilities mean the
surgeons can see each other as well as the patient's
insides. They have a pen they can use to point out anatomical
landmarks � something similar to the telestrator pen
tool used by sports broadcasters like Howie Meeker.
The local surgeon controls the power and makes all the
incisions and inserts the specialized robotic arms into
the patient. From that point, the remote surgeon can
either take over, remotely directing the instruments
inside the patient, or mentor the local surgeon using
voice and video broadcast.
Although there are still some limitations
when telesurgery is used over long distances � specifically
because the technology is not yet quite in 'real time'
� experts say it's inevitable that robotics will change
the way surgery is done in Canada. "Anything that requires
a great deal of interaction on the part of the surgeon
won't be so easy to do, because of the time lag between
the signals going back and forth," says Dr Rajni Patel,
PhD, director of engineering for CSTAR. The procedure
uses a dedicated network provided by Bell Canada and
Dr Patel says delays range between 60 milliseconds to
over half a second. Every millisecond counts, but he's
confident it won't be too long before faster data transfer
technologies eliminate time lags in telesurgery. At
present, though, "simpler procedures are possible,"
he says.
FULL
STEAM AHEAD
Robot technology is also racing towards your local operating
table. Another group of scientists are working furiously
to create even more complex robots. The laboratories
of California-based Intuitive Surgical, which acquired
the makers of Zeus, just gave birth to da Vinci, a new
model of surgical robot. Da Vinci provides four-armed
surgical ability and 3D vision. For all this you'll
pay a hefty $2.2 million US. Da Vinci differs from Zeus
in that it doesn't have telesurgical capabilities; it's
used only in local settings. Intuitive Surgical say
they have no plans to develop the telesurgery side.
For now, they're focusing their developments on local
robotic surgical tools capable of performing complex
cardiac and urological procedures.
Da Vinci was recently used to perform
the first-ever robotic radical prostatectomy. Prostate
cancer patient Archie Laidlaw, a 63-year-old dentist
from Sault Ste Marie, had his prostate removed by the
robot operated by Dr Joseph Chin (see photo), with assistance
from urologists Dr Stephen Pautler and Dr Patrick Luke
in April at the University Campus of London Health Sciences
Centre. The doctors hope this kind of approach will
lead to faster recovery of urine control and reduced
risk of erectile dysfunction for prostate cancer patients.
REMOTE
REAPING
Meanwhile, the expansion of telerobotics forges on.
Dr Patel and his team are investigating the potential
of existing remote technologies, particularly haptic
sensors, which sense touch and send feedback to surgeons
via specialized equipment. "The hand actually feels
the force that is felt at the tip of the instrument,"
explains Dr Patel. "The difficulty here is to try and
make this as transparent as possible so that the force
that is felt at the tip of the laparoscopic instrument
is reflected accurately to the surgeon's hand."
Fine tuning aside, telerobotics
proponents remind us that robotic technologies have
already paid dividends for surgeons. "Visualization
and precision are dramatically improved," says Dr Richard
Novick, citywide chief of cardiac surgery in London
and project leader of CSTAR's Robotics Research Grant.
"There's the ability to do more precise operations through
smaller incisions, and tremor is eliminated."
Dr Novick goes on to highlight
a number of benefits. For one, there's a strong possibility
that robotic surgeries will mean lower morbidity. And
although procedures may take a little longer when performed
robotically, smaller incisions and more precision mean
a shorter healing time for patients.
"There's also a potential to reduce
healthcare costs," says Dr Novick, adding that the cost-benefit
is increased the more often robotic surgical procedures
are used. Telesurgery's team-oriented process reflects
trends in medicine. From its multidisciplinary design
down to the OR setup, telesurgery is a collective effort.
"As you get to the more innovative areas, it becomes
even more a team sport, where individual team members
are yet more important," he says. "The surgeon is just
one small part of it."
For more information on tele-technology,
please link to: Telemedicine
revolutionizes long-distance consults (NRM issue
16)
For further information, visit CSTAR's website:
www.c-star.ca
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