DaVinci Robotic Surgery first in Canada

Peering into health care's crystal ball: The robot will see you now

LONDON, Ont. — Doctors here have performed a Canadian first, using a robot to help perform throat surgery without having to cut the patient open. Dr. Anthony Nichols and Dr. Kevin Fung, part of a team at the London Health Sciences Centre, used robotics to go through the mouth and throat to reach a cancerous lesion on a patient's larynx.

The medical team performed the minimally invasive laryngectomy, or removal of a small portion of the voice box, Dec. 3 on patient Gildard (Gil) Legere, 72."I feel great," said the now cancer-free resident of Sarnia, Ont., who stayed in the hospital for a week but who was able to eat chocolate pudding the following day.
Normal hospital stays after traditional, open throat surgery last about two weeks, so Legere said he didn't hesitate when offered the chance to be a guinea pig for the surgery in Canada, "They told me I had cancer and I couldn't get rid of it," said Legere, who says his wife thinks his voice is a now a little lower. "What was there to decide?"

Perhaps best of all for patients: the new surgery reduces the need for radiation or chemotherapy. In Legere's case, he would have had to undergo the taxing treatments five days a week for seven weeks.

Instead, doctors tackled the cancer from the inside.
"As a surgeon, you actually feel like you're standing inside somebody's larynx," Fung said of the high-tech procedure that features 3D and high-definition video. "So the capacity to see is unbelievable.
"We have very precise movements where we're not limited by the line of sight. We have different cameras where we can actually see around corners. We can really operate in a completely different way than we're used to."

Throat surgery is considered a four-handed operation, with one surgeon cutting and the other sitting at the patient's head, working the mouth retractor and the suctioning. The DaVinci robot provides three thin arms holding a camera and two surgical tools. A surgeon sits at a separate console looking into an eyepiece resembling binoculars. The doctor puts his or her hands into an apparatus, which then mirrors the movements of the fingers.

Even better, it can scale movements down for higher precision, reacting by, say, one centimetre for every four centimetres a surgeon moves. And it eliminates hand tremors. In some ways, it was just luck that gave Legere a chance to be a Canadian first.

Both Nichols and Fung had recently returned from a weeklong training course in September at the University of Pennsylvania, where they learned how to perform the surgery, when they met Legere.

They considered him an ideal candidate.
The advantages of the surgery, which can be offered only to patients whose mouths can open wide enough and who are otherwise suitable for surgery, are numerous: it sidesteps radiation therapy, it's cheaper, it cuts down on hospital stays, it doesn't dramatically change the sound of the voice and it doesn't leave any scarring.

The successful throat surgery is only the latest in Canadian and world firsts performed at the London Health Sciences Centre, which has used surgical robots since 1999, including for double-bypass surgery.
Dr. John Yoo, chief of head and neck surgery at LHSC, predicts more operations will be performed using robotics. Since performing the first robot-assisted throat surgery in Canada in December, the LHSC has performed another and has two more planned.

"There is an ever-increasing incidence of the kinds of cancers where robotic surgery could be applicable," Yoo said. "I think the application of the robot will increase over time."