Surgeons in Halifax, patient in Saint John

When 4 neurosurgeons on Canada's East Coast recently removed a patient's brain tumour, 2 of the doctors weren't even in the operating room. In fact, Drs. Ivar Mendez and David Clarke were in an empty OR at the Queen Elizabeth II Health Sciences Centre in Halifax, while Drs. Simon Walling and George Kolyvas were 400 km away at New Brunswick's Saint John Regional Hospital. Between them, they performed a successful craniotomy.

This procedure was the first of a 2-phase initiative spearheaded by the Division of Neurosurgery at the QE II. Mendez, head of the Division of Neurosurgery at the QE II and Dalhousie University, says the goal is to establish telerobotic neurosurgery in order to let patients at smaller centres throughout Atlantic Canada take advantage of the expertise that exists in Halifax without leaving home.

The telesurgery team used a $500 000 Socrates Robotic Tele-Collaboration System, which allowed the neurosurgeons in Halifax to control a robotic arm that manipulated a powerful endoscope. The endoscope had a miniature camera that hovered about a centimetre from the surface of the patient's brain, providing a complete view of the surgical field. A 2-way video and audio feed, in conjunction with a sophisticated neurosurgical navigation system, allowed Mendez and Clarke to monitor all aspects of the surgery. A specially designed stylus further enabled the Halifax neurosurgeons to highlight key areas of the brain precisely and to draw incision lines, which appeared simultaneously on another video monitor in Saint John.

“The potential benefits of robotic teleneurosurgery are tremendous for a small centre like ours,” says Walling. “This technology allowed us to bring expertise in real time from a larger centre.”

In addition to improving outcomes, Mendez thinks the new system has the potential to shrink waiting lists, cut travel costs and reduce family stress. The cost is currently too high to make the surgery feasible in most centres, but Mendez says this will change as the cost decreases. — Donalee Moulton, Halifax