Doctors can now perform robotic procedures from afar. What that means for rural Canadians | CBC Radio

Even from a few kilometres away, Dr. Vitor Mendes Pereira is able to perform a critical diagnostic procedure, thanks to an internet connection and a remote-controlled robot. 

“Every minute counts,” Pereira told 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 is really the ultimate goal of this type of treatment.”

The team at St. Michael’s Hospital in Toronto has performed 10 brain angiograms — a procedure used to get detailed images of blood vessels in the brain — through this remote-controlled robot over a fibre-optic internet connection. 

But that’s just the start. The same team hopes to perform a remote endovascular thrombectomy — a critical surgery to remove blood clots — via robot, for a patient about 500 kilometres away in Sault Ste. Marie.

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

It’s an advancement that doctors say could have a positive impact for stroke patients in rural parts of Canada, and across the globe.

How it works

From his control room, Pereira is able to perform the angiogram by using the robot to maneuver a catheter through the patient’s arteries and veins. The entire time, Pereira can talk to a team in the operating room alongside the robot and patient.

“Communication is very important on every step that we are doing,” said Pereira.

Over the 10 surgeries, they’ve progressively increased the distance between where the surgery is happening, and where Pereira is working from.

At first, he was in the room. Then, he performed the procedure 12 metres away. In the most recent procedure in August, he operated on someone at St. Joseph’s Hospital from six kilometres away in St. Michael’s Hospital, both part of Unity Health Toronto. 

A chief concern when operating using the internet is that you might lose that connection. But Nicole Cancelliere, program manager and technologist at St. Michael’s Hospital, says there are safety mechanisms in place.

“Fortunately, because of all the testing we did … this is not something we experienced, but we would be able to adapt in a scenario if that was to happen,” she said.

Making a difference

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

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

I think it’s going to be a game changer for the whole world– Dr. Michael Kutryk

The first place they hope to deploy the technology is Sault Ste. Marie.

Dr. Michael Kutryk, cardiology department chief at Sault Area Hospital, says the hospital doesn’t have its own team that could perform this surgery. Instead, patients are taken by air to Sudbury.

“These patients often suffer significant morbidity … because of the transport times,” said Kutryk, who says there are about 12 to 17 strokes in the area that would require this surgery each year.

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

But with the robot, and Pereira working remotely from Toronto, a patient can be treated onsite, potentially hours before the patient could be treated otherwise. Kutryk says it can significantly increase positive outcomes, while also keeping patients closer to home and their loved ones.

“I think it’s going to be a game-changer for the whole world,” said Kutryk.

Cost

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

Additionally, there would need to be a team on call that could operate the robot from another location.

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

The surgical robot costs between $1 million and $3 million. Each procedure also requires one-time use equipment, which is an additional cost. 

Having a solution that we can buy time, I think that it will convince any [health] authority– Dr. Vitor Mendes Pereira

To be worthwhile, Giles says the robotics system would need to be used several times a year. Additionally, she says, new tech like this isn’t top of mind for physicians working in rural hospitals, as centres across Canada grapple with having to close their emergency rooms.

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

But Pereira and Kutryk both say it can save on costs elsewhere, as patients who deal with disability after a stroke need more care, compared to someone who can be treated quickly and is able to have a more positive outcome.

Pereira and his team are currently conducting a cost-effectiveness study, but he thinks the technology is well worth it. 

“One robot in a hospital can save up to $2 million to the health-care system every year if we perform up to 20 of these procedures,” said Pereira. 

“I think time is one of the most challenging factors for us to deal with in medicine overall, and having a solution that we can buy time, I think that it will convince any [health] authority that needs to approve a technology like that.”