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Robotic assisted radical hysterectomy a Canadian first - The breakthrough is a boon to women with cervical cancer

February 27, 2008
For Immediate Release

London, Ont. - London surgeons have become the first in Canada to perform a robotic assisted radical hysterectomy, a breakthrough surgical accomplishment that dramatically reduces recovery time, pain and complications for women requiring the surgery.

In a collaborative approach, the procedure was performed at St. Joseph’s Health Care, London with a daVinci Surgical System by gynecologists Dominique Lanvin and Akira Sugimoto, who specialize in gynecological cancer surgery at London Health Sciences Centre (LHSC). The landmark procedure marks the debut of a surgical robot in gynecologic cancer surgery in Canada.

Radical hysterectomies are most commonly performed on women with cervical cancer, which affects about 1,300 Canadian women each year. It is an extensive procedure involving the removal of the uterus, cervix, top part of the vagina, ovaries, fallopian tubes, lymph channels, and tissue in the pelvic cavity that surrounds the cervix.

The standard radical hysterectomy requires a large incision in the abdomen, an invasive procedure with a hospital stay of several days for the patient, followed by weeks, even months, of recovery time.

Radical hysterectomies have also been performed using laparoscopic techniques without the assistance of a robot, but only a limited number of surgeons use this technique. Without the robot, manual manipulation of the instruments and visualization apparatus make the task tiring, difficult and time consuming for surgeons, explains Lanvin, who was recruited from France to further develop advanced laparoscopy in gynecology oncology in London.

With the da Vinci robot, minimally invasive surgery has entered an exciting new phase, says Lanvin. The robot provides the surgeons with a 3D view of the surgical field and full manoeuvrability of the instruments by way of easy-to-use joystick controls. In fact, the robot allows the instruments to perform actions normally difficult or impossible by hand, says the surgeon.

For patients, recovery from a radical hysterectomy using the daVinci requires only a two day stay in hospital, with a full recovery complete within two weeks. The first procedure was performed on December 19, 2007 and to date five patients have undergone the procedure. All are doing well.

While still in the developmental stage, this new achievement should allow more surgeons to perform laparoscopic operations and offer this option to more patients in the near future, says Sugimoto.

It also opens the door to unique teaching opportunities, adds Dr. Monique Bertrand, Head of the Division of Gynecologic Oncology at the Schulich School of Medicine and Dentistry at the University of Western Ontario. “The technology, early advancements with its use in London, and the capacity for physicians across the city to work collaboratively will enhance training for today’s surgeons and those of tomorrow.”

For more information, contact:
Rachelle Wood, Communication Consultant
Corporate Communications and Public Relations
London Health Sciences Centre
(519) 685-8500, ext. 77642
After-hours assistance:
Call LHSC Switchboard at (519) 685-8500 and ask to page the communications consultant on-call.

Dahlia Reich, Communication Consultant
Communication & Public Affairs
St. Joseph’s Health Care, London, (519) 646-6100 ext. 65294

London Health Sciences Centre
London Health Sciences Centre (LHSC) is one of Canada’s largest acute-care teaching hospitals and is dedicated to excellence in patient care, teaching and research. LHSC has pioneered many national and international medical breakthroughs. Located in London, Ontario, LHSC encompasses three sites, South Street Hospital, University Hospital and Victoria Hospital; two family medical centres; and the London Regional Cancer Program. LHSC is the home of the Children’s Hospital and CSTAR (Canadian Surgical Technologies & Advanced Robotics). LHSC is affiliated with The University of Western Ontario. Physicians and staff at LHSC number more than 9,000 and together they provide care for more than 1 million patients last year.

St. Joseph’s Health Care, London
St. Joseph’s Health Care, London is a major patient care, teaching and research centre with a distinguished legacy of service to London, Southwestern Ontario and the veterans of Canada, dating back more than 130 years. St. Joseph’s five key role areas include acute/ambulatory care, complex care and veterans care, long-term care, rehabilitation and specialized geriatrics and specialized mental health care. Facilities and services including St. Joseph’s Hospital, Parkwood Hospital, Mount Hope Centre for Long Term Care and Regional Mental Health Care London and St. Thomas are part of the St. Joseph’s family. Our research arm, the Lawson Health Research Institute, continues to direct their research to the development of new knowledge that is continually being applied directly to patient care. More than 400,000 patients annually receive care from close to 6,000 physicians and staff at St. Joseph’s. St. Joseph’s is affiliated with the University of Western Ontario.


da Vinci Robotic Surgical System
There are seven daVinci robots in Canada, including two in London.

How it works
The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and instruments that work like wrists. The surgeon, guided by a high-resolution, enhanced three-dimensional image of the surgical field, manipulates master controls on a console to operate the robot’s arms. The dexterity of the robotic arms allows the surgeon to be even more precise than could be done manually or with traditional minimally invasive instruments. The system is designed to scale, filter and seamlessly translate the surgeon's
hand movements into more precise movements of the EndoWrist® instruments.

Uses at St. Joseph’s Health Care, London
The daVinci robot has been in use at St. Joseph’s since April 2005. It assists surgeons in performing a number of laparoscopic procedures, including radical prostatectomy for the treatment of prostate cancer, pyeloplasty for kidney obstruction, partial cystectomy for treating endometriosis of the bladder, and cholecystectomy for the treatment of the gall bladder. Its use is expanding into the areas of gynecology and gyneoncology. In July 2006 at St. Joseph’s, the system was used to perform Canada’s first robotically assisted total laparascopic hysterectomy. The latest procedure – a radical hysterectomy – is much more extensive.

Uses at London Health Sciences Centre
London Health Sciences Centre acquired its first surgical robot in 1999 and in that year was the first hospital in Canada to perform robotic cardiac bypass surgery. LHSC established CSTAR, Canadian Surgical Technologies & Advanced Robotics (CSTAR) in 2000 as a research and education program in partnership with Lawson Health Research Institute and The University of Western Ontario. In 2003, LHSC purchased a daVinci robot. The daVinci robot has been used in one world, two North American and five Canadian firsts at LHSC, most recently in the first Canadian gallstone surgery and the first Canadian totally endoscopic closed-chest robotic bypass surgery, both in 2007. Surgical robots are regularly used at LHSC in a selection of urological procedures, cardiac procedures and in general surgery.