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This article was originally published on The Spec, by Jeff Mahoney.

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First-ever MAKO Rio surgery robot in Canada comes to Hamilton, for knee replacement surgery and research

Their bedside manner might be a bit, well, mechanical but, on the plus side, no massive med school debt.

Robots. There'll come a day soon, presumably, when we'll be asking of the surgeons who do our knee replacements and other complex operations not what universities they trained at but what factory they were built in.

Robot surgery is not just coming, it's here and it takes a big step forward in Hamilton on Thursday with St. Joseph's Healthcare Hamilton unveiling Canada's first orthopaedic surgical robot, the MAKO Rio Surgical Robotic System, which will be used to perform knee and, in time, hip replacements.

"I'm very excited about it; it's the first one ever in the country," says Dr. Anthony Adili, of the MAKO Rio, previously available only outside of Canada (chiefly in the United States), and acquired by St. Joe's as a first step toward creating a planned Orthopaedic Robotic Surgery Centre in Hamilton.

Everyone involved in the project is excited about it, but no one has more cause to be than Dr. Adili, orthopaedic surgeon and chief of surgery at St. Joseph's Healthcare Hamilton.

Right now, he is the only surgeon trained to use the robot, and soon he should be guiding it in actual knee replacement surgeries, but only ones (for now) being done for research purposes.

"The first procedures are scheduled to be done in January," says Dr. Adili. "We have to generate research so that (determinations about the role of the robot in surgery and health care) can be evidence-based.

"We will be trying to assess the economics. Is it cost-effective (to use a robot rather than conventional surgery)? We will develop a body of evidence."

The way it works, he explains, is that 3-D cameras and miniaturized surgical instruments are placed in the patient's body by the robot; the robot can plan a 3-D model of the surgery by marrying the anatomy to the image from the CT.

"We can decide where exactly we want the implant and lock it in."

The human surgeon presides over all this, from a console, manipulating the robot's arms with a joystick, says Dr. Adili. "The robot does all the actual cutting."

The benefits of robotic surgery include smaller incisions and less small tissue cutting.

"The robot can be so much more accurate and pinpoint and that's what's exciting."

Another advantage is that the robot is highly mobile and can be linked to the human surgeon from afar.

All of this, of course, is not cheap, and one of the biggest challenges in getting the robot here was raising the money. Every surgery comes with variable costs as some parts of the instruments must be replaced, each time.

The MAKO Rio acquisition, in the $2-million range, was made possible by investments through the City of Hamilton's Hamilton Future Fund; support from Stryker, the orthopaedic robotic technology owner with its Canadian headquarters in Hamilton; and donations from other grateful St. Joe's patients and community members. But the original impetus and catalyst behind the effort was a $1-million donation by a Hamilton couple.

While the initial outlays and ongoing upkeep and maintenance might run high, says Dr. Adili, robotic surgery could prove more cost efficient than conventional surgery in the long run if measured by patient outcome — fewer replacements and repeat visits.

"Interestingly," says Dr. Adili, "I started my career as an electrical engineer. I always felt we could do better (using technology to improve surgical procedures)."

Now, this city has a chance to prove him right. And he couldn't be happier for the opportunity, to be the first, and the first, he hopes, of many.