The Current - How does remote-controlled brain surgery work?

Episode Date: November 20, 2025

A surgical team at St. Michael's Hospital in Toronto has started doing brain angiograms using a remote-controlled robot. We speak with Dr. Vitor Mendes Pereira, the neurosurgeon who has performed 10 of the procedures, and Nicole Cancelliere, a robotic medical radiation technologist at Unity Health Hospitals, about the potential of the technology, and how it can save lives and save the health system money by offering access to neurosurgical care to people living in remote communities.

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Hello, I'm Matt Galloway, and this is the current podcast. I'm Rebecca Zanbergen, sitting in for Matt Galloway. Usually, when you're getting surgery, you'd expect the doctor to be physically touching you or at the very least in the same room. But is that about to become old-fashioned? It's great. I can see. I'm seeing. I'm saying it's good. It's good. That's a surgical team at Toronto's St. Michael's Hospital performing an angiogram using a remote-controlled robot. The neurosurgeon is across town in a different hospital. Okay, team, the device is in the sheaf. I pass on the control.

Dr. Vitor Mendes Pereira is the neurosurgeon behind this breakthrough, along with Nicole Cancelerre, who is a robotic medical radiation technologist at Unity Health. hospitals and they are both with me now, Dr. Pereira, Nicole, good morning. Good morning. Good morning. So Dr. Pereira, I'll start with you. Just describe the procedure. What were we listening to there? So I was actually telling the team that I was starting to take control of the robot, so I was not in the room. So the communication was very important on every step that we are doing. And the cerebral angiogram is the first step of a procedure that we called endovascular, surgery. This is a specialty that we assess arteries and veins in the head and we treat strokes,

brain aneurysms, all through the arteries and the veins, and usually it's in the leg or the arms, and we navigate these catheters all the way up to the head to perform these procedures. And so you aren't physically in the room but controlling all of this through a robot? Yes. Wow. And through what kind of connection? I mean, is this just an internet? connection of some kind? So for this experiment, we started for four years different connectivity solutions and parameters. We did many simulated surgeries. And in Toronto, between these two hospitals, the fiber optics is the fastest connection and they're also the most stable one. I assume you have to be doubly sure that it is stable. Everything is monitored on.

on the spot so for example we we have a stop so if the connection for some reason is delayed and it reaches 250 milliseconds between the actuation of the robot and the return of the action the the robot stops working so we have a message and it never happened and we performed these surgeries at 10 milliseconds delay so at 25 times fast. then our threshold for stop. And how are you physically controlling the robot in the room or hospital wherever you are? So I was at San Joe's Hospital, so San Jose and San Mike's are part of the Unity Health. So these hospitals have already good connection.

And I was remote controlling the robot using a keyboard and using a mouse and an interface in a computer screen. screen. Wow. How many procedures have you done this way? This way we've done 10. So we progressively went further away from the room. So we use remote control and the first procedures we were in the room. Then at San Michael's, we have a remote robotic room in the OR, which is 40 feet away from the room, the operating room. And we do surgeries there because the robots are, are more precise, they are more comfortable and for us as a surgeon's as well and for the patient. And we did a number of surgeries from that room until we go to the San Jose to remote control,

the robot at Sunmikes. And so this is a diagnostic surgery. You're figuring out at this point where a clot is or something. Yes. So for these cases, we were figuring out different aspects of the vessels. so they had different diseases. And this is the first step of a surgery. So to do an endovascular neurosurgery,

we have to start with a diagnostic angiogram. And then the next step is to move to smaller devices to then perform the procedures. Okay, an endovascular is always going up through an artery. This is never like an open brain surgery that we're talking about here at this point. That's it. Yeah, okay.

Nicole, where are you during all of this then? Yeah, so I'm beside the patient. And so there's two teams in these scenarios. We have the operator who's in the remote location and myself as a robotic technologist that's bedside. Right. And so have the patients been weirded out at all by any of this? No. Actually, from their perspective, they don't see anything much different.

There's no feeling during the procedure. So they're actually not even aware that there's any difference. And is the voice of Dr. Pereira, is that available for them to hear as well? Are they conscious through this? They are conscious through the procedure, and I can talk them through and speak to them, let them know when we're doing certain images, asking them to hold still. We do various imaging procedures that use contrast media. This might feel warm to them.

So we talk them through the procedure and let them know what's happening. But yeah, we keep them in sort of in the loop on every single step and make sure that they're comfortable. And how big is the actual robot on your end? Like what, I guess it's microscopic, but what exactly, how do, how would you know, if it was malfunctioning or something? So the main thing that could happen during a remote procedure, if you imagine, is the network connectivity. So what we would experience is just perhaps a latency or a loss of signal.

And this is being tracked the entire time during the procedure. And Dr. Pere and I are in communication the whole time. So if there was something like that, as Dr. Pere mentioned, there would be sort of safety mechanisms built into the robot, and we would be aware of that. fortunately because of all the testing we did, as Dr. Pereira said, this is not something we experienced, but we would be able to adapt in a scenario if that was to happen. Dr. Pereira, you said you sort of have been building up, sort of moving further and further apart through these diagnostic procedures, but was it nerve-wracking to begin

when you first did this? The fact that we went away progressively, it helped me. And doing end of vascular procedures, we are already far away from the head of the patient. So I'm a neurosurgeon, so I was trained to do craniotomies. And now I rarely do them because everything we do now is minimally invasive. But we have six years of experience with robotics. And that gave me confidence to now, I trust the robot and I see how, how address. advantages as it is for me and for the patient during the procedure.

And I was actually quite calm. Excellent. Okay. Well, you know, so far you've done it across town in Toronto, but what are the options here, really? How might it help health care in other ways? So the biggest aim is to deploy the robot in remote and rural areas, where the patients have to be transported to receive the type of care that we provide. So there aren't many hospitals that can have a team like ours to be on call 24 hours

with that level of expertise. So these patients, they are then transported to, for example, in Ontario, there are nine hospitals that can offer this kind of service. And when we will be able to deploy these robots, we will save time. And one of the diseases we treat with this kind of technical, technology and treatment is a stroke. And every minute counts. And if I can deploy the robot and treat closest to where the patient is, we can save hours. And that is really the ultimate goal of this type of treatment. Hello, it's Ray Winston. I'm here to tell you about my podcast on BBC

Radio 4. History's toughest heroes. I've got stories about the pioneers, the rebels, the outcasts who define tough. And that was the first time anybody ever ran a car up that fast with no tires on. It almost feels like your eyeballs are going to come out of your head. Tough enough for you? Subscribe to history's toughest heroes wherever you get your podcast. I understand one of the first places you're hoping to deploy the robot is Sue St. Marie. Yes.

And why is that? So Susan Marie is a town 700. kilometers from Toronto, their closest center to send patients at Sudbury. In the past, they used to send patients to us in Toronto. And they have a limitation on offering the expertise locally. And we work at the Brain Heart Center at San Michael's, and the cardiology team in our center does the support to their team over there. So that is the perfect scenario for us. we will be working with our team that we work at Sun Mike's that is over there at Sioux Saint-Marie and also we've been working and talking to the hospital there's a local willingness

to to work on this project together and that all the the circumstances came to have a be a good match and a good first place for us to to expand the remote robot to 700 kilometers. And when might that happen? So all these steps, every step, goes through approvals. So we go through RABs, contracts, Health Canada. So we hope at some time next year, we will have good news that we will finally be deploying a robot to do procedures in Sue St. Marie.

Wow. And Nicole, is there any change in what you do on your end, He's not just six kilometers away, but 700 kilometers away. Yeah, so this scenario with the doctor not being beside me, actually felt like not something new. It's something we've been, you know, practicing for a long time. And it is well within our scope to be, you know, assisting with the procedure on the imaging side and with the patient preparation. So there are some changes, obviously learning how to interact with the robot. But honestly, it didn't feel like anything experimental because of all the work.

development that we had done. So actually, it felt very normal. I felt very confident throughout the procedures. Are there other kinds of procedures, Dr. Pereira, that you think might be able to use this kind of technology as well? Yes, I think most of the endovascular procedures can be done. So stroke will be our ultimate goal, but cerebral angiograms, brain aneurysm, rapture brain aneurysmus. Some trauma, so sometimes they need in a trauma patient to close an artery that is bleeding and the surgeons are unable to close them surgically. I think there are many indications and remotely we can assist a lot the local teams in various types of procedure that may require endovascular support. I am curious how much

this cost, like getting one of these robots to, you know, Sue St. Marie, for instance, I don't know if that's in your purview to know the cost, but how expensive is it? I mean, these robots, we have the advantage of getting them early on, but I think usually a surgical robot is between $1 to $3 million, and every procedure there is a consumable, so a couple $1,000 per procedure of the devices that are dedicated, can only be used once. So this is how much a robotic system and a robotic surgery may cost. I suppose the flip side of that is how many lives do you think you'll be able to save because you've talked about the time it takes to fly someone to another hospital that has

the capabilities to do this kind of procedure. So do you assume if we can get this technology to other hospitals, you'll save lives? Yes. And when we look into lives and cost effectiveness, so stroke is one of the most powerful treatments we can offer in medicine today. So if we treat two patients, we can get one patient back to a normal quality of life. And this is a cost saving for the healthcare system in terms of rehabilitation, long-term stay, because it will all be significantly reduced. So by offering this treatment remotely. We are now conducting a study and one robot in a hospital can save up to $2 million to the health care system every year if we perform up to 20 of these procedures.

I suppose, though, they need to invest the front end to buy one of these robots, though, which do you think the province has, is there a willingness to do that? I think we, this, we will go through a feasibility phase. And certainly we are now conducting already cost-effectiveness studies. I think time is one of the most challenging factors for us to deal in medicine overall. And having a solution that we can buy in time, I think just that it will convince any authority or anyone in the Ministry of Health that needs to approve a technology like that. And I think the numbers in stroke are so impressive and how much it's life transformative

that any study and any feasibility study at the initial phase will already show the impact that this might have in patient's lives. Nicole, what else are you excited about when you're considering robot technology? I mean, it must be fun to be part of sort of pioneering all of this and being next to the patient. Oh, definitely. it's very exciting to be on that cutting edge. And our lab, the Radis Lab, is, you know, pushing the frontiers on a lot of different developments in this space, in the neurointerventional space.

I'm just really excited to have equal access to care for all Canadians. Stroke, you know, touches me personally with my grandfather who passed when I was very young. And so this technology, just knowing that it can help patients like my grandfather and families and save lives is just something that I'm truly passionate about. So I'm very honored to work on such an incredible team with such a passionate, you know, leader of our team, Dr. Pereira and everyone on our team at Unity Health and Radis Lab. Dr. Pereira, what about you? What are you most excited about as you look into the future of robotic technology? I am very excited with the access to care, but also with the improvement of the local care as well. I'm excited that robotics, as we've been showing in recent studies, it can get the surgical safety and the surgeons level to a very high end.

And I'm very excited as a professor. And I train many, many colleagues every year. And I see that sometimes there's a gap between the delivery of care. And I'm also excited that robotics can bring the surgeries that I've developed and I've developed. I've been practicing to a level of safety that can, it's unmatched and can be delivered equally and consistently in many places. So I'm very excited about that as well. Okay.

Dr. Pereira and Nicole, thank you very much for spending this time with us. It's our pleasure. Thank you very much for having us here. And looking forward to come back with more news next year. Yes, sounds good. Okay, Nicole, thanks again. Thank you. Dr. Vitor Mendes Pereira is a neurosurgeon at St. Michael's Hospital, and Nicole Cancelary is a robotic medical radiation technologist at Unity Health Hospitals.

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