A four-armed robot called the da Vinci performs surgery on a patient while a surgeon at a computer console manipulates the many-appendaged creation.
It's not a scene from Star Trek. This real-life technology marvel is now taking centre stage at Canadian Surgical Technologies and Advanced Robotics (CSTAR) in London.
Robotic surgery is one of many surgical advancements, and minimally invasive procedures at CSTAR - a comprehensive research program of the London Health Science Centre (LHSC), the Lawson Health Research Institute and the University of Western Ontario.
Since its inception in 2001, CSTAR has performed some of the world's - and Canada's - first robotic surgery, says CSTAR medical director Dr. Christopher Schlachta.
|Photo courtesy of CSTAR|
|CSTAR researcher Dr. Bob Kiaii positions the da Vinci's arms in preparation for a bypass procedure.|
In 1999, Dr. Doug Boyd performed the world's first robotic-assisted cardiac surgery on a beating heart. In September 1999, a farmer from southwestern Ontario was the first to have a closed chest (totally endoscopic), single coronary artery bypass on his beating heart.
To date, the technology is still in its infancy, and the work at CSTAR hasn't moved into mainstream hospitals.
However, many organizations outside the medical world have been quick to become part of CSTAR. In addition to the engineers, computer scientists, information technologists and researchers, CSTAR has partnered with private corporations to further the technology.
Johnson and Johnson, Stryker Canada - a surgical products and services company based in Hamilton - and Bell Canada are some of CSTAR's business partners.
Since 2002, Bell Canada has donated $800,000, which has been leveraged to $2.4 million from matching grant agency funding, such as the Canadian Foundation for Innovation (CFI) - an arm's-length government foundation that provides funding for research projects.
Bell Canada, one of CSTAR's first and largest partners, provides the networking system for telesurgery, and telementoring, whereby a fledgling surgeon in Whitehorse can learn a surgical procedure from a veteran in Toronto via video and voice conferencing. More than 15 surgical telementoring cases have been performed - from London to Toronto and London to Oslo, Norway.
"It was a natural fit for us to jointly partner in CSTAR," says Kathy Parker, director of southern Ontario for Bell Canada, based in London. "It takes our technology to a new level as well and we have engineers that are dedicated to work at CSTAR - our guys are getting things out of this as well as they help design and tweak the network with CSTAR staff."
Last year, the Lawson Institute named Bell business partner of the year. "It's nice when people recognize the time, effort and dollars - it's an honour for us to be named partner of the year," says Parker.
It's a reciprocal relationship says Marlene le Ber, director of CSTAR. "The granting agencies also want to do this to fuel the economy - they want to make sure any dollars that come from the public sector can fuel future economies."
Ultimately, the plan is to expand the technology and integrate it into mainstream hospitals, says Schlachta. "It's not what's happening right now - but the whole point is to introduce integrated surgery into the operating room and, of course, once we do that, it becomes limitless.
"Now we have image-guided surgery, image-enhanced surgery, teleprivate surgery - if I can sit 20 feet away from the patient, why can't I sit 10 miles or 200 miles away? That's something that we're actively researching here."
The project began in 1999 when Richard and Beryl Ivey, longtime health-care advocates, donated $1 million to purchase a Zeus, one of the first generation of surgical robots. The money became the catalyst for the current LHSC robotic surgery program.
In 2003, CSTAR opened a new, state-of-the-art, $12-million facility on the top two floors of the Legacy Research Pavilion at university campus of LHSC.
Canada has three da Vinci robots: Two in London, and one in Montreal. The da Vinci is made by Intuitive Surgical based in California and has replaced the Zeus robots. Today, da Vincis are worldwide and cost about $1.5 million US each.
Currently, only those living in London, or in close proximity, are able to become candidates for robotic surgeries. Patients must be recommended for surgery by their physicians, says Schlachta. About 60 patients a year undergo the surgeries, which he hopes will top 150 in the next two years.
The aim behind the robotics, and minimally invasive surgery, is to improve quality, safety and access to more complicated procedures, he says.
He explains that traditional surgery sometimes requires large incisions to get inside a body to receive good exposure. "But what we've done in the last 15 years in minimally invasive surgery, is we do the same surgeries without making the big incisions."
Therefore, for heart surgeries, no clamps are needed to pry back the rib cage and no rib bones need to be removed.
This means shorter healing time for the patient and less chance of infection.
Difficult procedures become less complicated with the aid of robotics, says Schlachta. "With prostate surgery, there is some evidence it can be done laparascopically. But only really done by virtuoso surgeons, it's a very difficult operation to do laparascopically without the robot. But with the robot it becomes easier and is also much more precise. It makes minimally invasive surgery more attainable for surgeons and therefore more available to patients."
Laparoscopics involves the use of a slender tubular endoscope - an instrument used to view the interior of a bodily canal or a hollow organ - that is inserted through an incision in the abdominal wall.
While robotics may decrease the wait times for these surgeries in the future, Schlachta says the technology to get there is still being tweaked. "When you're talking about health care, it takes a very long time from development of new technology to introduce it into common clinical practice."
To date, CSTAR has three patents filed, awaiting approval.
While some components and research are five years away from being put into practice, other research and development won't see the light of day for decades. "We are working on robotic technology and components not being used elsewhere in Canada," says Schlachta.
(Melanie Chambers can be reached at email@example.com)