By Niecole Killawee
Inside an operating room at the QEII Health Sciences Centre, Dr. Boris Gala-Lopez took off his shoes and sat down to perform a liver resection.
Seated at the console of a new Intuitive da Vinci Xi surgical robot, the hepato-pancreato-biliary (HPB) surgeon was notably comfortable. It was a small but significant detail in a profession known for long hours spent standing and holding awkward postures. The console is located near the patient, while the robot itself — equipped with a high-resolution camera and multiple articulating arms — is positioned directly above the operating table.
The console contains a 3D video display, two hand controllers, and foot pedals, the latter being why Dr. Gala-Lopez and many other surgeons remove footwear to get the best tactile control. Together, the console, the display, and the robot work to act as an extension of the surgeon’s own eyes and hands.
The day before, Dr. Gala-Lopez and his team introduced the da Vinci Xi into clinical care at the QEII after months of training and preparation. They started with routine procedures like gallbladder removals, operations typically performed laparoscopically, to establish their workflow with the new technology. Now, they were moving into more complex territory.
“I’ve practiced as an open surgeon, then laparoscopically, and now I’m exploring this robotics phase of my career,” said Dr. Gala-Lopez. For him, robotic surgery represents the next major shift in surgical care, much like laparoscopy did decades ago.
Robot-assisted surgery offers many of the same benefits first seen when laparoscopic techniques became a preferred alternative to open surgery: smaller incisions, minimized bleeding, and quick recovery. Robotics, however, extend those to a broader range of patients.
“When we’re able to minimize the invasiveness of surgery using a robotic platform, patients can recover faster. At follow-up appointments, you can really see the difference in the quality of the patient’s recovery.” – Dr. Gala-Lopez
From innovation to integration
The da Vinci Xi is the latest and most advanced addition to the Nova Scotia Health’s growing surgical robotics program, one that began as a health innovation initiative and has steadily moved toward integration into standard surgical care.
Surgical robotics were introduced to Nova Scotia Health in 2019 with the arrival of Atlantic Canada’s first da Vinci system at the QEII. In the years that followed, a strong collaboration between clinical teams, the Nova Scotia Health Innovation Hub, hospital foundations, industry, and government helped expand the province’s robotic surgery capabilities.
In 2021, the Health Innovation Hub worked with partners to bring Canada’s second Stryker Mako surgical robot system to the QEII, followed by an additional Mako system for the Dartmouth General Hospital in 2022. This momentum supported the early development — and ongoing evolution — of a Centre of Excellence in Robotic Surgery at the QEII.
The da Vinci Xi model is now the seventh surgical robot to arrive at the hospital and the eighth overall, thanks to generous contributions from 1,300 QEII Foundation donors, including Tony and Julie Metlege, David and Dinah Grace and the Orchid Women’s Health Initiative, who came together to raised $3.8-million. Earlier this month, the Foundation also unveiled the new Anthony and Mouha Metlege Surgical Robotics Suite.
The new technology is already driving several Nova Scotian firsts in robot-assisted surgery, including the first procedures in HPB surgery, colorectal cancer, and thoracic surgery. It’s also expanding access to robot-assisted procedures for patients requiring surgery for gynecologic and urologic cancer and ear, nose and throat cancer.
For patients, the impact can be immediate. Faster recovery means less time in hospital, reduced reliance on post-operative pain medication, and a quicker return to daily life. For cancer patients, that recovery timeline can be especially critical, allowing them to move on to further treatments such as chemotherapy sooner.
“This is health innovation in action — bringing together clinicians, donors, government, and industry to deliver real impact for patients. The da Vinci Xi and the Centre of Excellence in Robotic Surgery show how Nova Scotia is building the partnerships and capacity needed to expand access to advanced care and strengthen our health system for the future.” – Doris Grant, Managing Director of the Nova Scotia Health Innovation Hub.
Seeing (and doing) surgery differently
When reflecting on that first complex liver resection case, Dr. Gala-Lopez pointed to the da Vinci Xi’s powerful visualization. The platform provides surgeons with up to ten-times optical magnification, digital zoom, and 3D views.
“It allows you to visualize things I’ve never seen before… and I’ve been operating a long time,” said Dr. Gala-Lopez. “You lose some depth perception with laparoscopy because the display is two-dimensional, but with robotics you regain it and can see anatomy in a way that allows you to work more precisely and more safely.”
The robotic arms can also bend and rotate well beyond the range of the human wrist, offering a level of dexterity that allows surgeons to work within narrow spaces and around delicate structures with greater control. For some patient populations, such as those with a history of prior surgery or tumors located near critical vessels, the added flexibility can be the difference between an open operation and a minimally invasive one.
Together, enhanced visualization and greater instrument flexibility allow surgeons to work with a level of precision that makes minimally invasive surgery possible for patients with complex anatomy and other high-risk factors.
Building capacity for the future
Rather than standing for hours at the operating table, surgeons using the da Vinci Xi operate from a seated console. Improved ergonomics may help reduce the physical toll of surgery over time — a factor Dr. Gala-Lopez linked to broader patterns of burnout and earlier retirement within the profession.
“Ergonomics has become a hot topic in surgery,” said Dr. Gala-Lopez. “After 30 years of operating, your body is really affected.”
The same technology making surgery more comfortable is also reshaping how surgeons are trained. For years, advanced robotic training meant leaving Canada. Having robotics platforms like the da Vinci Xi in Nova Scotia supports local training programs and helps attract high-calibre trainees and surgeons who increasingly expect exposure to robotics and seek positions where those tools are available.
As director of the Americas Hepato-Pancreato-Biliary Association-accredited HPB Surgery Fellowship Program at Nova Scotia Health and Dalhousie University, Dr. Gala-Lopez knows how important this is for strengthening surgical care delivery in Nova Scotia long-term. Increasingly, surgeons and trainees expect exposure to robotic platforms and seek positions in centres where those tools are available, he said.
Another way the da Vinci Xi supports better care over time is through the detailed procedural data it generates, which can be used for quality improvement, system planning, and research.
“Investments like this are about more than technology — they’re about people. Advanced tools like the da Vinci Xi help us attract and retain exceptional clinical talent while giving our teams the resources they need to deliver high-quality, specialized care close to home. This is a meaningful step toward the next generation of healthcare in Nova Scotia.” – Dr. Nicole Boutilier, Executive Vice-President of Medicine and Clinical Operations at Nova Scotia Health
As robot-assisted surgery continues to become integrated into care at Nova Scotia Health, more patients will benefit from minimally invasive procedures, surgical teams will work with greater precision, and the health system will be supported by a highly qualified workforce prepared to adopt advanced technology so Nova Scotian patients can receive cutting-edge care.
