Since its launch in November 2018, the A.B. Smith QC Robotics program at Kingston Health Sciences Centre has changed the lives of more than one hundred patients in southeastern Ontario. In a traditional open surgery, patients experience long, deep incisions that can lead to discomfort and a lengthy recovery period. But, with the support of a robotic system, patients can experience faster recovery times, less pain, and decreased need for blood transfusions. In many cases, they walk out the doors of the hospital and return home the next day – a concept that would be inconceivable before the introduction of robotic-assisted surgeries.
“I used to say this is the future of surgery. This is no longer the future. This is now.” – Dr. Robert Siemens, KHSC Urologist
Meet da Vinci
Let’s make one thing clear – robots don’t perform surgery. Rather, the skills of trained surgeons are enhanced by a robotic operating system called da Vinci. This system makes no decisions on its own and acts as an extension of a surgeon’s own hands, but with superior visualization, manipulation and precision.
The da Vinci system seamlessly replicates the movement of the surgeon using the remote-controlled micro-instruments, performing surgery through small incisions in a patient’s chest or abdomen. This partnership of human and machine can reduce trauma to the patient’s body, duration of hospital stays, blood loss, transfusions, and use of pain medication.
“You certainly feel like you’re doing a better surgery because you can see the different planes much more easily,” says Dr. Jason Izard, a surgeon at KHSC. “The instruments you have to work with are so small that the movements and dissection is much more precise.”
Laparoscopic surgeries, which also use minimally invasive approaches, are not new to KHSC. But, surgeons are limited by inflexible tools and must work in a prolonged awkward position to get the best visibility of the surgical site. With the assistance of the robotic control console, physicians can improve both their visual and physical access to the surgical site and perform incredibly delicate movements with ease.
“We have been expanding our capabilities – both the scale and scope – in minimally invasive surgical procedures for many years,” says KHSC CEO Dr. David Pichora. “The evolution is not new, but there has been a rapid expansion and escalation of what we can do with the addition of the robotic-assisted technology.”
Compared to the human hand, robotic micro instruments have greater flexibility and range of motion. Here, a physician uses the da Vinci robotic console to practice suturing.
The surgeon maintains full control of the micro-instruments using their fingertips to navigate and make small, precise movements. “It would be a great deal harder for a much larger human hand to perform certain movements on the inside of the body,” says Dr. Izard
When the surgeons look through the robotic console, they see much more than they typically would on a screen. “We have a 3-dimensional view of the inside of the patents,” explains Dr. Izard. “The camera has two eyes, just like we do, and the view that you get through the camera is the same view that you would get from your own eyes looking inside the patient.”
Surgeons operate the da Vinci console from an ergonomic, seated position, allowing them to focus on the task at hand. “It’s much more comfortable,” says Dr. Izard. “As opposed to contorting your position to be able to see, or bending over the patient to throw a stitch or make a move that require you to contort your own body, you’re actually sitting at a console making the robot do small, precise movement which is much more effective.”
A team of supporters assist throughout the procedure by prepping the patient, setting up the different instruments to attach to the robot, positioning the camera and lighting, applying clips, using suction and more.
Putting KHSC on the map
Janice Kelly, an operating room nurse at KHSC, has been working robotic surgical cases since the da Vinci system was first brought to Kingston.
“The learning experience has been absolutely incredible,” says Janice. “It’s innovative from a nursing perspective too, and it’s amazing to see the outcome for the patients.”
With a myriad of advantages, it’s no surprise that robotic-assisted surgery is on its way to becoming the new standard of care in North America. It has become a keystone technology used in providing minimally invasive surgeries and is the ideal approach for a growing number of clinical situations,
“This program is bringing the hospital up to speed with what is happening in the medical profession,” explains Janice. “It’s an opportunity for KHSC to make a name for itself because we are providing this outstanding care for our population.”
Right now, the robotic-assisted option is offered for certain types of prostate, rectal, gynecological and general surgeries, but plans are being built to expand the program for even more patients who would benefit from this innovative surgical approach.
“If we don’t jump on board with robotics now, we will be left behind in the next decade,” says Dr. Romy Nitch, medical lead for surgery and chair of the robotic implementation committee at KHSC. “We came in at an opportune time. If we are able to build a strong, sustainable program there is huge potential to grow here.”
"Not only are we doing surgeries that we have never done before, but we are able to do them and our patients go home the next day," explains Janice. "It’s a huge benefit for the patient and their family. Being a part of that is super awesome."
A core group of physicians and nurses who have been working closely with the da Vinci system since it's first day of operation.
"Its created an extreme learning experience for everyone," says Janice. "We had a learning curve, we had an adjustment, and now its running smoothly and we know what we are doing. It’s a great opportunity for nursing staff and also gets the residents up to speed with what other facilities are doing."
Though technically retired, Kathleen likes to stay busy by working and conducting research for a local professional and author. She has lived throughout Canada, and even spent a number of years living in the Caribbean.
“Everyone always asks me why I came back,” she laughs. “I missed my family. It was time to come home.”
Kathleen is no stranger to surgery - the 64 year old has had 12 operations her lifetime. Last summer, Kathleen learned that her uterus needed to be removed, which is when she first learned about robotic-assisted surgery.
“I wasn’t against it, I just didn’t know anything about it,” explains Kathleen. "All I knew is that I wanted this surgery done as quickly as possible.”
It didn’t take long to convince Kathleen that a robotic-assisted surgery was the way to go. Aside from being able to have her surgery quickly, the biggest benefit she saw was being able to manage her post-op pain without medication.
“I have a very low tolerance to medications,” explains Kathleen. “With this type of surgery, the pain normally would be so much higher. I was rating my pain afterwards at a level three [out of ten]. I’ve had many other surgeries and let me tell you, there was a huge difference. The pain was so much more manageable.”
After four weeks of recovery, Kathleen, along with her niece and great-nephew, packed up the minivan and travelled all over Ontario– something the family wouldn’t have been able to do if Kathleen had a traditional hysterectomy. She was also able to work comfortably, free from pain, from her home shortly after leaving the hospital.
“It was an unbelievably better experience,” she says. “There is less chance of infection. There was less downtime than I would have ever thought. I’ve never felt more confident about a prognosis or procedure than I did with this one.”
The future of robotics in Kingston
We have the skilled clinicians, the patients, and the technology, but we are missing one key piece to secure the future of the program: ongoing donor support. Robotic technology is expensive, and community donations are needed in order to secure the program and allow it to thrive.
KHSC is fortunate to benefit from the support of local philanthropist Britton Smith, whose generous donation allowed the hospital to purchase the da Vinci robotic operating system. To recognize his support, the program has been named the A. Britton Smith Q.C Robotics Program.
"Brit has made an exceptional commitment to investing in the future health of our community," says Dr. Pichora.
Work is underway through University Hospitals Kingston Foundation to ensure that KHSC can continue changing the lives of even more people living in Kingston and throughout southeastern Ontario.
“It required significant group effort and community support to bring da Vinci to our center and we will require ongoing philanthropy to sustain the program,” explains Dr. Nitch. “I feel quite proud that we’ve been able to bring this technology on board. We have challenges ahead from a funding point of view, but I’m optimistic we will get there.”
To find out how you can support world-class health care in Kingston and surrounding communities, please visit uhkf.ca