Need a knee replacement? St. Joseph’s Healthcare has a robot that does that
St. Joe’s will do research to prove the technology works to avoid pitfalls plaguing robotic prostate cancer surgery.
Feb 25, 2019, by Joanna Frketich The Hamilton Spectator
Canada’s first knee replacements by a doctor-controlled robot have taken place at St. Joseph’s Healthcare as part of a study to prove the effectiveness of the technology and avoid the ongoing funding pitfalls plaguing prostate cancer surgery.
The robot has been used in four knee operations since Jan 18 in a pilot study funded by hospital donors.
“It’s very fledgling,” said Dr. Anthony Adili, who did the surgeries. “We’re just starting down a very exciting path … At the end of the day I think patients will benefit immensely from this new technology.”
St. Joseph’s, which specializes in robotic surgery, is getting the proof it needs from the start to show the technology is worth the extra cost so it doesn’t end up embroiled in the same dispute it faces with prostate cancer surgery.
“We’re in a golden opportunity to do that kind of pivotal research to inform our decision-making,” said Adili, chief of surgery at St. Joseph’s. “The research is being done (elsewhere) but it’s not high quality research so it’s hard to make definitive decisions and definitely difficult to make policy decisions. We want to produce that high quality data.”
The research is significant because a lack of evidence was behind a controversial recommendation in 2017 by the Ontario Health Technology Advisory Committee (OHTAC) against publicly funding robotic surgery to remove a cancer patient’s prostate gland.
It was a stunning blow to St. Joseph’s, where the vast majority of radical prostatectomies are done with the help of the da Vinci robot system.
Currently, the province pays the hospital the same price as the traditional operation and donors make up the extra cost of the robot. It’s an increasing burden on the St. Joseph’s Healthcare Foundation as the robot is rapidly becoming the surgery of choice with men from Kitchener to Niagara willing to travel and wait longer to get it.
A final decision on whether the province will eventually fund the robot for prostatectomies at an estimated cost of $800,000 — $3.4 million a year has been put off while St. Joseph’s gathers evidence on how it saves the health care system in other ways, such as a faster recovery time, since it’s no longer possible to do randomized trials.
“It’s so ubiquitous and it’s almost the standard of care,” said Adili. “It’s impossible to randomize someone to robotic prostatectomy versus an open prostatectomy. Nobody will go for it. We lost that opportunity.”
Orthopedic robotic surgery was approved in Canada and the United States only in the last year so high-quality studies can still be done. It’s the same for robotic thoracic cancer surgery with St. Joseph’s already running a multicentre trial.
“We don’t know who it’s going to benefit so we can do these randomized trials and develop that data that will help drive decision-making,” said Adili.
The biggest roadblock is that St. Joseph’s is the only centre in Canada doing robotic orthopedic surgery, making a multi-site trial of thousands of patients impossible to do here. With a price tag of $2 million a robot, it will be hard to find other centres with the appetite to join in.
“We’re going to have to partner with centres in the United States and convince them to contribute data,” said Adili. “The problem is they are buying robots like crazy because it is driving their business. They are going to be less inclined to want to randomize one versus the other. Some of our progress will be hampered until we get more units in Canada because Canadians have a very different mindset and will participate in trials.”
In the meantime, St. Joseph’s has started the pilot study that it hopes will provide enough evidence to get grants for the eventual large trial.
It’s important because Adili says one in five patients are currently unhappy with the outcome of their knee replacement and the robot’s precision could drop that number substantially. In addition, it makes partial knee replacements much easier, so surgeons will be more likely to do them.
“By replacing just the bad part of the knee, I’m leaving more of the patient’s normal anatomy behind,” said Adili. “It should feel like a more normal knee, recovery should be quicker and they should have better functionality. A total knee, although it is a successful procedure, it still does not match the mechanics of a normal knee.”
With the popularity of the robot for prostate cancer, Adili doesn’t expect any difficulty in recruiting patients.
The first was 66-year-old Peter Sporta from Oakville, who waited an extra two months to get a robotic partial knee replacement on Jan. 18.
“I wasn’t scared at all” Sporta said about being the first patient. “I couldn’t wait.”
Sporta was in the hospital for one night and walking the next day.
“Within three days I threw away my crunches and my cane,” he said. “For sure I would recommend this.”
Two Hamilton researchers will study post traumatic stress in emergency services
Media Outlet: Hamilton Spectator | Date: February 14, 2019 | Reporter: Joanna Frketich
Hamilton researchers are teaming up with scientists in France to determine the links between mind and body that could one day bring about more personalized mental health treatments.
“The hope for the patients one day is that when they come with depression, we don’t give them only an anti-depressant,” said Dr. Flávio Kapczinski, professor of psychiatry at McMaster University and St. Joseph’s Healthcare.
“We give them a whole strategy on how they would get outside the risk zone for depression.
“We could give them exercise, correct their metabolism with some sort of diet and give them anti-inflammatories.”
The partnership with the Pasteur Institute was one of three new Hamilton mental health projects launched in February.
The other two will investigate post-traumatic stress injuries (PTSI) in public safety personal such as firefighters, paramedics, police officers and correctional workers.
Both received grants of up to $150,000 from the Canadian Institutes of Health Research as part of $2.95 million in federal funding announced Feb. 8 to studies that increase understanding of how to identify, treat and prevent PTSI.
Margaret McKinnon, chair in mental health and trauma at McMaster, will do a randomized control trial to test a new way to treat PTSI in public safety personal with other health conditions.
Occupational therapist Sandra Moll plans to design a mobile health approach to prevention and peer support.
“Public safety personnel put themselves in harm’s way to protect Canadians, putting them disproportionately at risk of post-traumatic stress injuries,” federal minister of public safety and emergency preparedness Ralph Goodale said in a statement.
“Our country must do more to protect the mental well-being of public safety officers on-the-job. The initiatives will help address gaps in PTSI research and inform long-term plans to support the mental health and well-being of our public safety personnel.”
Meanwhile, the new partnership with the French researchers is significant because it gives St. Joseph’s Healthcare and McMaster access to basic science research that they don’t have now.
In turn, they offer Pasteur large cohorts of patients from West 5th hospital that the French are currently missing.
“We are accumulating a lot of data in this field now and thanks to this collaboration we’re going to have access to large cohorts,” head of Pasteur’s perception and memory unit Dr. Pierre-Marie Lledo said during a trip to Hamilton on Feb 7.
“We get a full picture of how the brain functions by having access to the clinical data.”
It’s also unique because French researchers generally team up with Quebec investigators.
“When France would partner with Canada they never crossed the Gatineau River,” said Kapczinski.
“Now the commitment of the French Embassy is to bring to the attention of French scientists this whole perspective of dealing with many other centres like McMaster. We are looking to the idea of strengthening the scientific links between Canada and France.”
So far, funding is primarily from their own institutions and the French Embassy, but they are working on applying for grants to study many different potential mind and body links.
“We were finding our patients when they have depression, they have a lot of inflammation in their blood,” said Kapczinski.
“We didn’t know the cause of that. Pasteur is famous because it’s where immunology and inflammation started to be understood … so we reached out to the director and he was very excited.”
Other questions vary from gut bacteria to exercise to metabolism to electric signalling between fatty tissues of the brain.
“People who suffer from depression they suffer a lot of brain changes like accelerated aging,” said Kapczinski.
“The brain and the body as a whole starts to age faster and we want to understand the mechanisms associated with that.”