Surgical robot improving outcomes for Kingston patients

07 Oct, 2024

In the heart of Kingston General Hospital resides a four-armed robot that is making a positive impact on the lives of patients and surgeons at Kingston Health Sciences Centre (KHSC).

The A.B. Smith QC Robotics program at KHSC launched in 2018 with the purchase of the da Vinci Xi, a four-armed surgical robot that creates a magnified, three-dimensional and high-definition image for surgeons while they operate using a set of handheld and foot controls that move the robot’s four arms, equipped with the required surgical instruments.

Since then, the robot has assisted surgeons to complete hundreds of surgeries, and its presence has helped to build the largest and most comprehensive robotic colorectal surgical program in Canada.

“It is technology that significantly improves patient outcomes and health system outcomes, in terms of length of stay, (emergency department) visits, readmissions, all of those pieces that are so key right now,” Michelle Mackay, the program operational director for perioperative services at KHSC, told the Whig-Standard during a tour of the program on Wednesday.

Not only is KHSC leading the charge in robotic colorectal surgery. They’re also the only program that has four different types of surgeries being completed on the same robot, Mackay said.

Surgeons at KHSC are completing colorectal and thoracic robotic surgeries, as well as procedures in urology and gynecologic oncology.

And the organization’s surgeons are palpably enthusiastic about the tool that’s not only improving patient outcomes, but also making their jobs easier.

Inside the operating room

The da Vinci robot is hard to miss— a four-armed centrepiece inside one of Kingston General Hospital’s operating rooms. Surrounding the robot are pieces of technology that help it to do its job, including two console stations with large computer screens, foot-pedal and hand-operated controls into which surgeons insert their fingers and hold in a way that would mimic the use of surgical instruments.

Dr. Sunil Patel, a colorectal surgeon and the medical lead of the A.B. Smith QC Robotics program at KHSC since it began in 2018, pointed out that not only does the robot help with patient outcomes, it also ergonomically helps surgeons be more physically comfortable in their jobs.

Whereas traditional surgeries often require body positions that can stress surgeons’ necks, spines and arms, the robot’s seated control stations are adjustable for the user.

“You can work in small, little places you can never get your hands into,” Patel said. “You have very stable instruments….there’s four arms on the robot — I have two. We can use four arms, including one holding the camera. It’s stable, (a) good picture (that’s) not smeared or anything.”

Dr. Ameer Farooq, one of the hospital’s colorectal surgeons, pointed out the robot’s ability to help prevent surgical injury in complex surgeries with the use of its dye and imaging system.

“It’s literally like turning a camera light on and off,” Farooq said, describing the heightened visibility that the dye facilitates in different parts of the body.

While the surgeons who operate using the da Vinci robot have undergone extensive training in its function, so have other hospital staff.

Michelle Parslow is KGH’s operating room clinical care lead, and she described the initial training into how to prep the robot for surgery as “a brand-new concept.”

“But setting up the robot now is pretty easy,” she said. She and other staff have learned the set-up routine, as well as the preferences of the different surgeons who use the device.

“It’s definitely interesting to see how far we’ve come from when I started in the (operating room) until now,” Parslow said. “It’s pretty impressive….We made big incisions, recovery time was longer, then laparoscopic surgery, and now (we have) robots and patients are going home the next day.”

Patel said that the role of Parslow and others in the surgical team can get downplayed, but that they are vital.

“They have invested a tremendous amount of time…it’s a huge departure from what they usually do, and I think it’s anxiety-provoking, coming into this,” Patel said. “They want to make sure that we’re happy and we’re doing things in an efficient way, and that the patient’s safe. It can really make or break the OR.”

Colorectal surgery

Kingston has been honing its robotic colorectal surgical program for five years, and its three colorectal surgeons are about to complete their 500th surgery with the robot.

The program completed 150 robotic colorectal cancer surgeries in the past 12 months, which is nearly twice their initial goal of around 80 per year.

“We’re quite proud of how far we’ve come in five years,” colorectal surgeon Dr. Hugh MacDonald said, pointing out that the program is a leader in Canada for volume of surgeries completed.

According to the surgeons, there’s been a dramatic decrease in the need to convert a large incision, something that could happen during laparoscopic procedures. There are also fewer ostomy bags being utilized post-surgery during recovery.

While some procedures happen without the robot, nearly all of KHSC’s colorectal cancer surgeries are now being done through robotic surgery, for patients not only from the area but across the region spanning from Trenton to Smiths Falls and Brockville.

“I think what we’re pleased to see achieved is that, although other centres will do colon cancer surgery minimally invasive, but for the pelvic surgery they do not have access to this,” MacDonald said. “We believe we have something more to offer. So for the first time in many years, all of the rectal cancers now in our region are coming to Kingston.”

It’s a good news scenario for patients, who recover much more quickly, sometimes going home from the hospital in one or two days instead of the expected seven to 10 days for these procedures done in a traditional way with big incisions.

MacDonald said that post-op patients who undergo robotic surgery are returning very quickly to their normal lives, regaining gut function and mobility.

Facilitating learning

As an instrument to facilitate learning, MacDonald said that the da Vinci robot “far exceeds anything we could have done laparoscopically” in training the newest surgeons completing residencies with KHSC.

“With the robot, there’s two consoles, so there can be the attending surgeon at one, and a learner at another, and we can flip back and forth. We can actually assign a single instrument to the learner, and keep control of the others, or we can transfer them all over.”

The robot also has a unique simulator function that allows learners to experience a surgical procedure before becoming involved in a real-life scenario.

Farooq, the newest surgeon on the colorectal surgical team, believes that the robot is providing vital opportunities for surgeons to grow their skillset within KHSC, setting them apart in Canada.

“I think one of the strengths of our programs is because it’s not so established, we have a really robust method for onboarding new surgeons, and I’m the beneficiary of that,” he said. “I think now we’re one of the few programs in the country that has a really robust program for training both residents and fellows, particularly for general surgery and colorectal surgery.”

Robotic lung surgery

It’s been one year since thoracic surgery became part of the robot’s growing surgical portfolio. The procedure is less invasive, requiring smaller and less invasive incisions, which incurs less pain and less blood loss than other surgical approaches.

Dr. Andrew Giles, a thoracic surgeon with KHSC, said that while the robot hasn’t shown a dramatic difference over conventional minimally-invasive surgery, it has shown a significant decrease in the number of times a patient requires a big open incision to complete a surgery — from 10 per cent to two per cent.

“But more importantly, I think it’s enabling us to do things that we weren’t previously able to do through other techniques,” Giles said.

The robot is helping surgeons to identify and remove smaller and smaller lesions in earlier-detected lung cancers through highly technical operating techniques that Giles said he was never taught how to do.

Giles completed a fellowship at Mayo Clinic in Advanced General Thoracic Surgery, which included training in robotic thoracic surgery.

The techniques he discussed involve preserving more lung tissue than previously thought possible.

“It was considered not to be possible through conventional techniques, but we’re now doing it routinely,” he said.

The robot is also helping to make complex surgeries more accessible.

“About 70 per cent of (lung cancer patients) are able to have (surgery) with the robot because we can do some advanced maneuvers to make it a safe operation, even though it’s a very advanced operation.

“So we’re basically shifting the standard of care from things that previously weren’t offered to surgery to things that can be,” Giles said. “And now, for the things that can be, but through a big incision, to things that can be done just like any other minimally invasive operation.”

Expanding Kingston’s robotic surgery program

KHSC wants to make robotic surgery available to more patients, and to that end hopes to acquire a new da Vinci robot in 2025. The purchase price is around $3.5 million, with ongoing operational costs to run a second robot in the program.

“It’s about a half a million dollars per year, per robot,” Mackay said. “That’s supplies and service.”

But the proven positive and improved outcomes from robotic surgery procedures are worth the expenditure, Mackay said, explaining that shorter hospital stays, fewer emergency department visits or readmissions, and the fact that patients who have undergone robotic surgery often bypass the intensive care unit entirely and go directly to surgical recovery, or even home, substantially offset the cost.

“It’s technology we really want to invest in, because it’s the direction of health care,” she said.

The robot purchase will only be possible with support from donors.

“Quality comes at cost, and we’re looking to bring everyone together in the community to support this, because this in turn provides such great outcomes for our patients, which is our top priority,” Mackay said.

For information about donating, visit www.uhkf.ca.

View full article from The Kingston Whig Standard