The sound of a surgical drill echoes through the atrium at Dartmouth General Hospital and a fine powder puffs up from the “knee” that Dr. Jennifer Leighton is operating on.
The drill is attached to a large, futuristic looking cart, which is in turn connected to a computer monitor that renders a precise graphic representation of the changes she’s making in the mock-up joint.
It’s an impressive demonstration of how robots have become part of the orthopedic surgery team at Dartmouth General.
The Mako SmartRobotics system now in use at Dartmouth General gives surgeons incredibly precise control of their instruments and is also valuable in the planning phase.
“It allows us to plan in 3D before the surgery all of our implant choices and placement to allow it to fit to the bone very concisely for each patient,” Leighton said in an interview before the media demonstration Friday at the hospital. “That means we can really specialize it to the needs and to the anatomy of each patient we see.”
“It also allows us to accommodate their soft tissues or how their ligaments, their tendons work within the knee or the hip and that allows us to very precisely deliver that care.”
A national first
Leighton and her surgical team recently made history by doing the first total hip replacement surgery in Canada using the Mako system.
The only other hospitals in the country that use the $2.5-million surgical robot are at the Halifax Infirmary and St. Joseph’s hospital in Hamilton, Ont.
Besides breaking technological ground, Leighton said it’s an exciting development because of the benefits robotic assistance brings to surgery outcomes.
“Hip and knee replacement surgery, it’s excellent surgery, they’re some of the best surgeries that have been provided to date, and yet we still have patients that aren’t happy or that need re-do surgery and that’s a big burden on the system and a horrible burden for the patient.
“So what we’re looking to do is narrow that gap, improve those outcomes so that Nova Scotians are much happier with their replacements and need fewer surgeries in the future.”
Nova Scotia also has some of the longest wait times for orthopedic surgeries in the country. Leighton said it’s not yet clear whether robotic surgery will reduce those waits but fewer knee and hip surgical revisions means surgeons will have the time to do more primary surgeries.
Other benefits to patients include less pain, quicker recovery, shorter hospital stays and more natural feeling movement after surgery.
'Amazing' recovery
One of Leighton’s patients, Helen Young of Cole Harbour, said she was amazed at how quickly she recovered from recent knee surgery that involved the robotic assistant.
Young said she had her surgery at about 11 a.m. and was home by 5:30 p.m.
“It was amazing really,” said Young, 69, in a phone interview before the news conference.
Leighton removed dead bone material, related to a condition called osteochondritis, from Young’s knee and replaced it with a metal prosthetic.
“I did have pain,” she recounted. “When you leave the hospital, they put a nerve block that lasts for 24 hours. When that came out, it hurt, but you do have pain medication and I did my exercises.”
But she was quickly able to handle the stairs at her home and she was back at work doing transcriptions of medical letters within days.
At $2.5 million, the Mako system is a big investment and Dartmouth General donors have been generous enough that the purchase has been pre-approved as the fundraising campaign continues, said Stephen Harding, CEO of the hospital’s foundation.
“It’s an exciting day, the future is now,” Harding said, calling the national first of the robotic-assisted hip replacement surgery “a great milestone for Dartmouth General. … It’s something the foundation and our donors are proud to support.”
Besides Leighton and the foundation, the collaboration on the robotic surgery expansion includes Nova Scotia Health's innovation hub and perioperative services team and Mako manufacturer Stryker, a leading international medical technology company.
“Expanding the type of services we can offer through the Mako SmartRobotics System is allowing us to provide the most innovative surgical care in the country," said Dr. Gail Tomblin Murphy, vice-president of research, innovation and discovery for Nova Scotia Health.
"We are so fortunate to have the support of philanthropic partners, like the Dartmouth General Hospital Foundation, and industry partners, like Stryker, who are essential in the optimization of transforming health and health care for Nova Scotians.”
