Doctors can now perform robotic procedures remotely. What this means for rural Canadians

Thanks to an Internet connection and a remote-controlled robot, Dr. Vitor Mendes Pereira is able to perform a vital diagnostic procedure, even from a few kilometers away.

“Every minute counts,” Pereira said. the current Guest host Rebecca Zandbergen.

“If I can deploy the robot and treat closest to where the patient is, that can save hours. And that’s really the ultimate goal of this type of treatment.”

The team at St. Michael’s Hospital in Toronto performed 10 brain angiograms — a procedure used to obtain detailed images of blood vessels in the brain — via this remote-controlled robot over a fiber-optic Internet connection.

But this is just the beginning. The same team hopes to perform remote endovascular thrombectomy – a vital surgery to remove blood clots – via robot for a patient about 500 kilometers away in Sault Ste. Mary.

Although it still requires approval from Health Canada, if performed, it would be the first time endovascular thrombectomy was performed remotely in the world.

Doctors say it’s an advancement that could have a positive impact on stroke patients in rural parts of Canada and around the world.

how it works

From his control room, Pereira is able to perform angiograms, using the robot to move a catheter through the patient’s arteries and veins. All the while, Perera can communicate with the robot and a team in the operating room with the patient.

“Communication is very important in whatever steps we are taking,” Pereira said.

In more than 10 surgeries, he has progressively increased the distance between where the surgery is taking place and where Perera is working.

First of all, he was in the room. Then, he completed the process 12 meters away. In the most recent procedure in August, he operated on someone at St. Joseph’s Hospital, six kilometers away, and St. Michael’s Hospital, both part of Unity Health Toronto.

The main concern when using the Internet is that you may lose that connection. But Nicole Cancelliere, program manager and technologist at St. Michael’s Hospital, says safety mechanisms are in place.

“Fortunately, because of all the testing we have done… it is not something we have experienced, but if it does happen we will be able to adapt in a scenario,” she said.

make a difference

Cancelliere says this development is personal for him. Her grandfather died of a stroke when she was young.

“Knowing that this can help patients like my grandfather and families and save lives is something I am really passionate about,” Cancelliere said. “I’m really excited for all Canadians to have equal access to care.”

I think this is going to be a game changer for the whole world– Dr. Michael Kutryk

The first location they hope to deploy the technology is Sault Ste. Mary.

Dr. Michael Kutryk, head of the cardiology department of Salt Area Hospital, says that the hospital does not have its own team that can perform this surgery. Instead, patients are airlifted to Sudbury.

“These patients often face significant morbidity due to transport time,” Kutryk said. He says there are about 12 to 17 strokes in this area that require this surgery each year.

“But that’s not a big enough number to hire a full-time neurointerventionalist in Sault Ste. Marie to do one procedure a month.”

But with the robot and Pereira working remotely from Toronto, a patient can be treated on-site, potentially just hours before the patient is due to be treated. Kutryk says this can significantly increase positive outcomes, while also keeping patients home and close to their loved ones.

“I think this is going to be a game-changer for the whole world,” Kutryk said.

Cost

To perform endovascular thrombectomy, the hospital will first need a robot used to perform remote surgery.

Additionally, there will be a need for a team on call that can operate the robot from another location.

Dr. Sarah Giles, president-elect of the Society of Royal Physicians of Canada, says that while it can provide life-saving or life-changing care quickly, it can be difficult for rural hospitals to manage those costs.

Surgical robots cost between $1 million and $3 million. Each procedure also requires one-time use equipment, which is an additional cost.

Having a solution we can buy time, I think it will reassure any (health) authority– Dr. Vitor Mendes Pereira

Giles says the robotics system will need to be used several times a year to be worthwhile. Additionally, she says, such new technology is not as top of mind for physicians working in rural hospitals as centers across Canada. Struggling with closing their emergency rooms.

“Right now, I would argue that we don’t even have the basics,” Giles said. “Before we get into things that are super sexy, I’d like to see a reinforcement of the basics in rural and remote Canada.”

But both Pereira and Kutryk say it could lead to cost savings elsewhere, because patients who suffer disability after stroke require more care than those who can be treated early and are able to have more positive outcomes.

Pereira and his team are currently conducting cost-effectiveness studies, but he believes the technology is worth it.

“If we do 20 of these procedures, a robot in a hospital could save the health care system up to $2 million a year,” Pereira said.

“I think time is one of the most challenging factors for us to deal with overall in the medical field, and having a solution we can buy time with, I think it will convince any (health) authority that needs to approve this kind of technology.”