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New remote robotic brain surgery could revolutionize aneurysm, stroke treatment

Technologist Nicole Cancelliere, left, and Dr. Timo Krings make adjustments to the robotic arm at Toronto Western Hospital. (Nick Boisvert/CBC)

Doctors at a Toronto hospital have performed what they’re calling the world’s first neurovascular surgery using robotics, a procedure that could open the door to heightened levels of precision and improved care for patients in remote communities.

The procedure was performed on Nov. 1 at Toronto Western Hospital to treat a patient who suffered a major aneurysm, a potentially lethal bulge of a blood vessel in the brain.

The complex operation to remove the aneurysm was performed via a remote-controlled robotic arm, which helped the surgeons guide a catheter to the patient’s brain from a single incision made near the groin.

The robotic device allows surgeons to make “submillimetric” adjustments during the complex operation, in which a catheter ultimately deploys a web of metallic coils at the site of an aneurysm, effectively choking it off from the rest of the brain. X-ray images provide a real time road map during the surgery.

“This machine can do what we do with four hands,” said Dr. Vitor Mendes Pereira, who controlled the robot during the operation.

“Robotics has been used in other areas of medicine, but never in this domain,” added Dr. Pereira, a neurosurgeon and neuroradiologist at the Krembil Brain Institute at Toronto Western Hospital.

Dr. Vitor Mendes Pereira controlled the robotic arm during the groundbreaking surgery. X-ray images are used to guide the catheter through the body. (Nick Boisvert/CBC)

While this procedure may be a first, Canadian doctors have been using robotics to perform brain surgeries since 2008, and the field is advancing rapidly.

Patients can be discharged on same day as procedure

In addition to aneurysms, the procedure done at Western can also be used to resolve ischemic strokes, which similarly block blood flow to the brain.

In both cases, the non-invasive surgery does not require the opening of the skull, and patients can sometimes be discharged on the same day the procedure is performed.

The patient in the groundbreaking surgery is now recovering, the hospital said. It isn’t releasing her identity due to privacy concerns.

“I can’t believe how lucky I am,” she wrote in a statement provided by Toronto Western Hospital. “I’m living proof that such procedures are possible through robotics.”

The $1.2 million machine is manufactured by Corindus, a Waltham, Mass.-based subsidiary of the German multinational conglomerate Siemens.

Resolving ‘dilemma’ in Canadian medicine

While the strategy of targeting aneurysms and other blockages with catheters and stents has been in use for most of this decade, navigating the tortuous vascular system requires significant expertise.

That complexity means that patients in remote areas such as Northern Ontario do not have access to the operation, which Dr. Timo Krings has called a “major dilemma” in Canadian medicine.

“The expertise to perform these types of procedures is not available everywhere, which means we cannot provide the standard of care to a large portion of the population.” said Dr. Krings, who was bedside during the robotic surgery. He is also a neuroradiologist at the Krembil Brain Institute.

Doctors deploy this metallic coil at the site of an aneurysm, which blocks blood flow to the damaged area. (Mark Bochsler/CBC)

Strokes, Krings explained, can kill up to two million neurons per minute, making fast treatment essential but difficult to access for many Canadians.

That situation could be improved, he believes, by installing robotic machines at more hospitals across Canada. As long as a trained technologist is on site to troubleshoot and manage the device, a doctor could perform the surgery remotely from anywhere in the world.

They are hoping to perform a remote surgery within the next year.

While Krings and Pereira say that robotic assistance could be a revolutionary improvement, they also acknowledge that some doctors may be hesitant to give up control of their craft.

“Normally we as physicians, we have to be and want to be bedside,” Dr. Krings said.

Krings said the robotic technology will ‘open the door’ to remote surgeries. (Nick Boisvert/CBC)

And although the groundbreaking surgery could have been performed without robotic assistance, Dr. Pereira said he was “very happy” to have used the machine, especially during a difficult portion in which he installed stents inside the patients’ brain.

“I personally changed my opinion about this type of technology, and I do think that with time other physicians will do so as well, if they see this robot in action,” added Dr. Krings.

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