Hello, Dr. Yasufuku
How are you?
Pretty good. How are you, Nadia?
I'm good. Thank you for your time today.
It's a pleasure to introduce Dr. Kazuhiro Yasufuku, who is a professor of surgery at the University of Toronto
Staff thoracic surgeon at the Division of Thoracic Surgery at Toronto General Hospital.
He is also the director of the Interventional thoracic surgery
program at the University Health Network
So Dr. Yasufuku, we know that you have been a leader in
the field of minimally invasive Diagnostics and Therapeutics for thoracic
malignancy and you have been conducting research on development of
new technologies in early diagnosis and Ultra minimally,
invasive thoracic surgery,
one of the minimally invasive procedures to treat
Lung cancer,
we learned that you can use a surgical robot called
Da Vinci system and The Da Vinci surgical system consists of multiple
arms that are controlled and manipulated by the surgeon to
make small incisions in the patient's body and it helps
to treat the early.
stage lung cancer.
we know that there are some pros and cons of
The Da Vinci surgical system.
So,
would you like to explain a little bit about it?
Thank you, Nadia. I think the question is the pros and cons of the robotic platform.
and maybe I'll just start out with a little history
of Robotics for especially for lung cancer in Canada.
So in 2011,
so this is 10 years ago in October.
I was the first Thoracic Surgeon to actually apply robotics
for lung cancer,
surgery in Canada.
It had started, you know, several years ago prior to that in the US and around the world. 36 00:01:40,600 --> 00:01:40,589 world,
but especially for Canada,
we were the first to introduce this. So I've been using
the technology for about 10 years and in simple words,
the robotic enhances the surgeons' ability to do surgery
in a minimally invasive way.
So,
traditional surgery used to be where we make a big incision,
we open that chest, and we can put
you know, our hands in, touch everything, and do the surgery.
But things have changed significantly in the past 20 years
where you know,
the majority of the surgeries that we do
are we trying to avoid making big incisions.
That's good for our patients because they recover quickly.
They have less pain.
But what is important is that you know,
when we try to make small incisions and try to
do a similar surgery from outside. It becomes
very challenging.
So we started out with we call it VATS
surgery or video-assisted thoracoscopic surgery where we place a camera,
we hold the camera we insert instruments and and we
basically move our instruments from outside to do the surgery.
But you can kind of imagine it's not very easy.
So the robot actually enhances the capability of
surgeons to move the instruments.
It moves,
you know,
in different angles and in different degrees,
so it's almost like having your hand inside of the patient.
Da Vinci system
also has a 3D view so you're actually now you
can see everything in 3D.
which also enhances,
you know,
the surgeons ability to do surgery.
So I think that's probably the biggest,
you know,
benefit of the Da Vinci and the way that it's made,
you can actually do the surgery through smaller incisions than
the traditional VATS surgery.
Which means that,
you know,
the patient will have smaller incisions and,
you know,
they they may have less pain.
So,
those are kind of the pros of the robotic surgery.
The con.
There's not a lot of cons,
but I would say that,
you know,
cost of the robot is an issue,
especially in our,
in the Canadian healthcare system because it's it's all paid by
tax money,
right? And typically robotic surgery,
if you look at the surgery itself
it is more costing than using the traditional instruments.
You know,
it cost a couple of million dollars to buy the
robot and every time you do the surgery the instruments,
you can only use so many times.
So there's a cost of using each instrument and also
the maintenance fee is is pretty tremendous.
You know, think about owning a car,
right?
You buy a car and that's not it.
You have to maintain the car. Similarly,
you buy the robot and,
you know,
that comes with the cost.
But other than that,
I, I think it's really a great tool for treating patients.
Thank you for sharing your thoughts!
So based on the information you have provided, what is your motivation behind
practicing robotic surgery?
I think as I mentioned, it does enhance the ability
of the surgeon to do a very precise surgery.
I think you mentioned that robotic is used for early stage.
But actually with the robotic you can actually do more
advanced disease surgery
where traditionally
We may have to open.
With the robotics, you can do it pretty well,
very safely.
The reason why I started robotic surgery,
you know, it was because of this.
But also I see a future of robotic surgery because
technology continues to get better and better and if you
do not
use the technology, you're going to be left behind.
So I think we constantly have to look at
what is available and the new technology and how
we can apply to our patients.
That's really inspiring.
Thank you for sharing and thought.
I guess you kind of answered this question earlier too,
but when do you prefer to do robotic surgery over
the conventional procedure like an open surgery?
Open surgery, we will pretty much only do open surgery when
it's necessary for instance, if it's a big tumor or if it's
for a procedure
like a lung transplantation where there is no option to
do minimally invasive surgery.
For patients
that have advanced disease where typically we had to do
open surgery,
the robot actually allows us to still do the surgery,
in a minimally invasive way.
So when you perform robotic surgery,
Is there anyone in the OR or operation room to
specifically take care of the machine?
Like how do you handle the situation when there is
an issue with the robot itself?
So, when you get training to do robotic surgery,
obviously you need to know,
you know,
if there are like the emergencies where the robot malfunctions.
you need to know all of that.
And all of the members of the,
OR,
they need to know.
So when I started this,
you know,
we had to go out for training,
we would go out training with specific OR nurses.
So everyone who is involved,
is aware of what to do in
emergencies, so if there is any malfunctioning.
There is a
a robotic coordinator or robotic nurse.
It's a real nurse,
not a robot.
but,
you know, she kind of oversees all of the robotic surgeries.
And,
she is the kind of dedicated nurse that can kind
of troubleshoot and everythings.
And there is always a medical engineer from the company,
that provides the Da Vinci.
So there's always someone that's assigned to our Toronto General Hospital OR
So that if there is any issues,
you know, they're available and they can kind of help us.
That's good to know! Have you ever encountered any difficulties using
the Da Vinturi system?
I'm very meticulous and I am very careful with what I do.
I try to prepare well in advance.
So,
in the ten years,
I've been doing robotic surgeries, I have had zero,
zero issues.
That's wonderful. Yeah
and I've never had
any, you know, significant emergencies as well,
and it's not just for robotics,
but you know, you have to prepare for everything,
right? Yeah.
I was going to say it's a lot of your
preparation that leads into like zero issues.
I see. Just like surgical robots develop and improve with
advancement of technologies
overtime,
people are slowly getting to know that there are robots that
help surgeons to perform better in surgeries,
But I'm sure there are some people who are still
hesitant to go through robotic surgery,
or simply cannot trust the robots to perform such an
important procedure.
What is the one thing you would like to
or you always tell your patient when guiding them through
different types of procedures?
How do you present information to your patients?
That's a great question.
And when we talked to our patients, we definitely
have to explain to them what surgery is about.
You know what we're
going to do. Then we start discussing about the different
approaches.
You know, and details.
So you're not going to say,
okay, we're going to do robotic surgery for you and,
you know, as a patient if you hear a robotic surgery,
you might imagine
"Oh,
so you're not going to do the surgery,
the robots going to do the surgery itself."
But you know,
that's not true. So
as long as you explain to the patient well
the difference of the different approaches and what robotic surgery is about.
No patience in the past,
ten years have been hesitant to go ahead with surgery
with robotic surgery.
The robot will not even move
unless we move the robot,
right?
The surgeon is responsible in moving the actual robot.
So if they get a wrong perception of what,
what robotic surgery is about,
they may not feel comfortable.
But as you know,
as long as you explain to them what it's about,
I had no patients (who had issues).
you know,
so far. And in fact,
a lot of the patients come to see me because
they prefer having the robotic surgery.
Even if they do come wanting robotic surgery,
I also always explain about the different approaches.
You always provide as much information as possible to guide
them through informed decision,
I guess? Of course.
That was very, very, informative.
How do you foresee the next coming 10 years?
Would you like to see more or less robots in health care?
Right now, there's many robotic platforms
that are being developed. So right now,
it's at the Da Vinci, right? Intuitive surgical.
They have the Da Vinci and that is dominating the market.
But there are other players that are coming out.
For instance,
Medtronic is coming out with a new robot called the
Hugo
And we at UHN,
we have the robot
you know, in our training center. And Johnson & Johnson,
they have been working with Google and they came up with
a company called the Verb Surgical.
When you see different companies
making new robots,
that's a good thing because it does drive the cost down, hopefully.
And when you have competition,
you know, the technology will always become better. And in terms of
the technology when you look at the past 10 years,
it's developed so much.
You know,
there is AI Incorporated.
So,
you know,
I think it's going to continue to get better and
better in terms of
the robotic platform. But as surgeons, we need
to make sure we can keep up with
that technology.
So it's going to be continuing education for us.
I see. Do you think surgical robots
will benefit some populations
who do not have adequate access to health care and
rely on remote healthcare?
Do you think robots in healthcare have potential to do so?
Interesting question because do you know the
history behind the Da Vinci robot?
It was actually the US Army who
tried to incorporate this technology so that,
you know,
they can apply this for soldiers that are kind of
fighting on the battlefield.
That was the initial thought of The Da Vinci.
And now,
the Da Vinci is where it is.
Now, it is potentially possible.
I can probably operate on someone,
you know,
100 km away but it's not just about moving
the robot. Surgery is all
it's teamwork.
You need your nurses.
You need your technicians.
You need your RT.
You need your anesthesiologist.
And you need the surgeon and the assistant.
And the robot is only one part of that.
So what is practical is that with the robotic platform,
if I wanted to proctor.
If I needed to help someone that's actually doing the
surgery. I can actually be hundred kilometers away and actually see
how they're doing,
and I can potentially help them.
Right? help them through the surgery.
That is possible.
You're now, you're talking about surgical robots,
but there are a lot of robots
available. For instance, in a lot of hospitals in Japan,
they have these robots that actually deliver the medication
within the hospital.
So that cuts the cost of human resources.
You don't need someone to kind of deliver
the medication but the robot can do that accurately
working together with the pharmacists.
So there's you know,
many things that I think it's not just a surgical
robots that will probably help our patients. I see.
And I'm sure the main message I think you want to provide to
patients or general public would be
to trust the physician.
And trust their skills to use the robots to enhance their ability
Yeah.
I see. Well, thank you Dr. Yasufuku for taking the time for us today.
I know you're very busy,
but your dedication to patients with your answers to our
questions in this session
definitely helped our audience in multiple ways.
So thank you again.
And we really appreciate your help.
You're welcome.