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ROSA ONE Brain adds to fleet of Nova Scotia surgical robots providing ‘best possible care for our patients’

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A surgeon wearing blue scrubs and a blue face mask operates on a patient's brain using a surgical robot. Two other surgeons dressed in blue scrubs with blue masks look on from behind him.

By: Heide Pearson

Dr. David Clarke, a neurosurgeon at the QEII Halifax Infirmary, is one step closer to understanding what’s causing one of his patient’s seizures after a landmark operation done with the help of a newly acquired surgical robot. 

The acquisition of the ROSA ONE robot was led by the Nova Scotia Health Innovation Hub in partnership with QEII Foundation, and supported by its generous donors. ROSA ONE is allowing epilepsy patients to receive more precise, tailored care, by assisting the neurosurgeon in the precise placement of electrodes, which are inserted deep into the brain for investigation of epilepsy. 

This operation is done when a patient’s epilepsy hasn’t been controlled with other medical therapies, and they’re running out of treatment options. About 30 per cent of epilepsy patients do not respond to medical therapy and will be considered for surgical treatment; as part of this investigation, electrodes may need to be inserted into the brain. The electrodes record the continuous electrical activity of the brain and can be critical in determining exactly where in the brain the seizures are coming from.

Traditionally, each electrode’s location is determined by physicians manually setting X, Y and Z axis coordinates to set a target for the electrode. A typical patient undergoing this surgery has an average of 10 electrodes inserted: the location of each is determined by about a dozen measurements, meaning the surgical team has to manually set more than 100 measurements per operation. That takes time and has the potential for human error.

The ROSA ONE does this more quickly and eliminates that potential for human error.

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A computer screen on the ROSA ONE surgical robot shows a map for inserting electrodes into a patient's brain.

To prepare for surgery using ROSA ONE, patients undergo an MRI and CT scan, both of which are uploaded to the ROSA software which creates a 3D model of that patient’s brain. The neurosurgeons spend two to three hours on the computer planning the placement of the electrodes. Then, once the patient is in the operating room and under general anesthesia, a metal halo ring is attached to their head so that the head cannot move and a second, portable CT scan is done. That scan is uploaded to the ROSA software and fused to the pre-operative MRI, providing the surgical team with a specific trajectory for each electrode. 

After a series of standardized checks, it’s time to start operating: the ROSA robot guides the process. At the press of a button, the ROSA arm positions itself along the trajectory of the first electrode so that the surgeon can drill through the patient’s skull and insert the electrode to the precise spot mapped out by the scans and software. Once the electrode is inserted, another press of the button and the robotic arms moves quickly to the next position, meaning each electrode is placed precisely in the planned location. 

These are the steps Dr. Clarke and his surgical team took for Nova Scotia Health’s first operation performed with the ROSA ONE in October 2024.

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Surgeons dressed in blue scrubs look at the screen of a surgical robot that is mapping out an operation to insert electrodes in a patient's brain.


Dr. Clarke’s patient, a young man with epilepsy, had nine electrodes placed in the left side of his brain with the aim of understanding where his seizures were coming from. 

For surgeons operating on the brain, this kind of precision medicine is greatly improving accuracy, and in turn improving patient safety and outcomes. 

“It’s important that people understand that the robot is not doing the surgery. There’s still a surgeon who is planning, is responsible for and is doing the actual surgical procedure, but the robot is providing critical assistance,” Clarke said. 

“Robotic technology enables us to achieve the surgical goals with precision and safety and by disturbing the patient’s normal anatomy as little as possible.”

In addition to guiding Dr. Clarke to the precise location for each electrode, the ROSA ONE also eliminates some steps and performs others more efficiently. The ROSA ONE will increase neurosurgery capacity, providing more care faster to patients in Nova Scotia and across Atlantic Canada who are waiting for answers. 

“It’s our expectation that this will reduce the operative time by 30 to 40 per cent,” Dr. Clarke said. 
“That’s a significant saving in terms of operating room utilization, particularly in this day and age when every minute of access is really critical.”

Expanding Nova Scotia’s robotic surgery capacity

The ROSA ONE adds to the fleet of seven surgical robots making up Nova Scotia Health’s Robotics Centre of Excellence, ramping up the province’s ability to treat patients more efficiently and effectively through increased precision medicine capacity. Other robots are already being used in neurosurgery and assisting surgeons in orthopedics, spine surgery and general surgery.

“QEII Foundation donors are on the frontlines of helping bring surgical innovation to the QEII. By fully funding the $1.13 million to purchase and to bring ROSA ONE to the QEII, to fully funding many of the other surgical robots in use, the QEII Foundation continues to be a leader in funding innovative health care solutions,” said Susan Mullin, president and CEO of the QEII Foundation. 

“We have an ambitious $20 million fundraising goal to help establish the Robotics Centre of Excellence to ensure Nova Scotians have access to the most advanced care available today. That includes having the best technology and integrating data into personalized patient care plans. It truly is an exciting time to be supporting health care.”      

Bringing more surgical robots to the province is a top priority for Meaghan Walker, Manager of Innovation at the Nova Scotia Health Innovation Hub. 

In the next few years, Walker and her team are working to bring more surgical robots to Nova Scotia Health facilities, thanks in large part to funding from the QEII Foundation and Nova Scotia Department of Health and Wellness. 

“As we bring more robots into the province, we can do research, we can add more coordinated data, we can look into the pre-operative and post-operative plans, and we can look into educating our current physicians, and bringing other physicians into Nova Scotia to learn with these robots,” Walker said. 

“The whole strategy is to develop leading expertise in robotic surgery in various different departments so that all Nova Scotians can benefit.”

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Large, circular lights are seen behind three surgeons wearing blue scrubs operate on a patient's brain with the help of a surgical robot.

The Robotics Centre of Excellence will establish four different pillars to make the program a success; procurement, data collection and analysis, education and training, and research. 

One of Walker’s goals is to use the data and research to ensure surgical robots are deployed to the right regions of the province to meet surgical demand, while simultaneously expanding surgeons’ skillsets and attracting more physicians to the province.

“The reason is the patients. This will allow our patients to get better care and have better access to care,” Walker said. “Instead of saying, ‘You need to fly to a different province or country to get your surgery,’ we will be able to say, ‘We have it here. We can help you here.’” 

“We want to make sure we’re meeting the needs of Nova Scotians with these robots.”

For Dr. Clarke, being at the forefront of clinical innovation is key to advancing and improving patient care.

“A vibrant academic environment provides support for research and innovation and attracts people of high quality to come and work here. It also attracts high quality trainees who come and want to learn these techniques from us,” he said. 

“But, most importantly, that vibrant academic environment provides access to the best possible care for our patients. I believe there is a direct link between research, innovation and the highest quality of patient care.”
 

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Dr. David Clarke poses with the ROSA ONE surgical robot in an operating room. He is wearing blue scrubs, glasses and a mask is hanging around his neck.