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By AMANDA PEDERSEN

Medical Device Daily Senior Staff Writer

Walking into The Hospital for Sick Children (SickKids) in the heart of downtown Toronto is an experience unlike any other. The first thing you might notice is the smell. SickKids doesn't smell like a hospital - you know, that distinctive antiseptic smell so common in most hospitals. Next you might notice the natural lighting, brightly colored cartoon characters painted on the walls and windows in the atrium, and even vender booths near the food court that create a kid-friendly atmosphere more like a shopping mall or small amusement park than a hospital.

SickKids was among the many stops on an international medical device media tour of Ontario that Medical Device Daily participated in last week. The tour, organized by the Ontario Ministry of Economic Development and Innovation (MEDI), also included journalists from Japan, China, London, Germany, France, and India.

If it had not been for the occasional directory sign pointing the way to things like X-Ray or the allergy clinic, we might have forgotten we were even in a hospital.

SickKids is unique in other ways too. Affiliated with the University of Toronto, the hospital is one of Canada's most research-intensive hospitals and the largest centre dedicated to improving children's health in the country. More than 40% of SickKids patients come from outside the Toronto area for services that are not available anywhere else in the province and in some cases, Canada. SickKids Research Institute is the largest child health research institute in Canada, drawing researchers from around the world. The hospital also includes a learning institute that supports educational endeavours for hospital staff, trainees, patients and families.

During the tour, the group had the opportunity to see some of the incredibly innovative research and developments that are currently taking place at SickKids. The most impressive of these by far was a robotic arm, the KidsArm, designed specifically for pediatric surgery that is being jointly developed by SickKids and MDA Robotics (Brampton, Ontario), the space company that built the Canadarm space arm for the Space Shuttle.

James Drake, MD, told the group that the robot is being developed to automatically do the tedious work of stitching patients up at a much faster pace than a human could.

Phase I of the development began in 2009 and is projected to end in 2012 when the team will begin the next phase of its development.

"We're hoping to have something that is working clinically within two years. It's ambitious . . . but we think we can do this."

The closest competitor of the KidsArm will be Intuitive Surgical's (Sunnyvale, California) da Vinci Surgical System, which weighs about 1,200 pounds, according to Drake. "There's no way that could ever operate on a small child," he said.

The KidsArm is expected to weigh somewhere between two and 200 pounds.

But the KidsArm is more than just a scaled down version of the da Vinci, Drake explained.

"The big difference is that this is a smart robot, the control system is actually being done electronically and the only information that the robot has is what's coming from those two pared video cameras there, just like two pairs of eyes, which gives the system depth perception," Drake said during a prototype demonstration of the KidsArm. "That's the only information it has, it doesn't really know beforehand, where the robot is sitting, where the suturing tool is or where the platform console is. It recognizes the suture pad, and where the robot is, just from the information from the video cameras. So if things change, it can adapt. If it was sewing something and something moved or something changed it can adapt to that . . . so it really has this smart component."

A representative from MDA told the group that what they have done is leverage the kind of technology they have already developed for space applications and applied it to the medical world by shrinking everything down by a hundred times. He pointed out that currently, to stitch up a wound, surgeons have to use awkward looking instruments to hold on to needles and basically perform a sewing job inside a very confined space. It's tedious and time-consuming and also requires a lot of concentration from the surgeon, he said. "So they could use some help from a robotic arm, which is what we're trying to do here." But, he noted, the idea is not to replace the surgeon but to simply introduce the system as a smart instrument at the point where the surgeon requires some mechanical help. Using a computer to operate the system, all the surgeon has to do is select the suturing points and then monitor what the robot does and cut the string when the suturing job is finished.

The researchers have set a high goal for the robot, Drake said.

"We want to see 10 stitches in 10 seconds. So something that can take a surgeon an hour to perform, we want to see a robot that can do it in 10 seconds, which will, I think, dramatically change the way that this kind of surgery is carried out. This is obviously just a test bed but we don't think the transition to abdominal organs like sewing a duct back together or even a blood vessel, we don't think it will be a huge change from what we're doing," he said.

Other projects in the works at SickKids include an MRI-guided surgical system as well as a simulation technology that will allow surgeons and medical students to perform practice procedures in a virtual reality environment. The student or surgeon would place a somewhat heavy helmet-like system over their head and feel like they are in an operating room, using surgical tools to operate on a virtual model of the patient they may be planning to operate on in reality the following week.

"The days of just practicing on live patients is over," Drake said when one of the journalists in the group asked if this type of system is really necessary to train surgeons. In addition to training surgeons on the system, he added that it would also be used to periodically test licensed surgeons in order for them to continue operating on live patients.



Published  November 30, 2011

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