Cardiology

Robots put on their scrubs

Endoscopic cameras, nano-robots, robotic gloves, 3-D visualization systems. “Surgical technology is booming right now and we don’t want to miss the boat,” states Dr. Michel Pellerin, holder of the Michal and Renata Hornstein Heart Surgery Chair at the Montreal Heart Institute.

An expert in minimally invasive surgery, Dr. Pellerin promises that within the next few years, Montreal will have its own surgical robots. To reassure a public wary of seeing a robot wielding the scalpel, he adds, “It’s important to understand that in robotic surgery, the robot becomes an extension of the surgeon’s manual skills. The myth of the doctor pushing a button to start the surgery and boarding a plane for some fun in the sun is just that—a myth.”

The technology that allows a doctor to control a robot by remote already exists. Dr. Pellerin is very familiar with it, having had the opportunity to learn alongside Dr. Alain Carpentier, the great architect of the first robotic surgery performed in 1998 at the Broussais Hospital in Paris. Using robotic gloves and a 3-D visualization system, the surgeon performed a real remote control operation. The robot delivered the goods: the patient was up and celebrating his 70th birthday a few days later, having sidestepped a more painful convalescent period.

While the first virtual procedures took place a few metres from the bed, doctors in Montreal will now be capable of performing surgery from even greater distances. “The distance factor is one of the benefits of robotic surgery. Another advantage is that when you manipulate your gloves, the precision of all of your movements is increased tenfold. A one-centimetre movement by the surgeon translates into a one-millimetre movement of robotic technology. What this does is eliminate the impact of any hand tremor,” adds Dr. Pellerin.

Developing an expertise in this type of surgery is a major component of the Chair, which was inaugurated November 4, 2004 at the Université de Montréal. Before attaining that goal, Dr. Pellerin will devote much of his energy to improving valve replacement surgery at the Institute. Dr. Pellerin plans to introduce the wide use of minimally invasive surgery that employs endoscopic cameras and a visualization screen. The conventional 12-15 cm incision in front of the sternum, a hallmark of more conventional surgery, will be replaced by a much smaller, five to seven centimetre incision in the right thorax. The cameras become the surgeon’s eyes and are able to more precisely make out heart structures.

Patients will benefit from this technology with dramatically reduced hospital stays and shorter convalescent periods. While this technology is not brand new, robotic surgery has not always received the necessary approval in Canada, though Dr. Pellerin thinks it is only a question of time. “It’s taken a while to become accepted. We know now that a good niche exists. The procedure has been tried a few times in Quebec hospitals, but we want to be the first in the province to offer this service on a large scale, in a serious and scientific manner.”