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Robotic surgery and the case for public funding

Prostate cancer is the most common non-skin cancer and the third-leading cause of cancer-related death among Canadian men. Over 20,000 Canadians are diagnosed annually with prostate cancer, many of whom will need a prostatectomy during the course of their treatment.

Robot-assisted technology used in prostate cancer surgery has become a global standard, with 82 percent of prostatectomies performed worldwide in 2017 using this technology. However, in stark contrast with the global statistic, only 27 percent of prostatectomies performed in Canada in that same year were robot-assisted, since many provinces do not fund this technology. The crux of the issue comes down to its perceived cost-effectiveness, but new research is providing a more complete understanding of the financial side of this innovative technology.

Dr. Bobby Shayegan, who has performed the highest volume of prostatectomies in Canada, stands with the new da Vinci Xi surgical robot. 


“St. Joe’s urologic surgeons prefer to use robot-assisted technology for radical prostatectomies and some other complex procedures that can be performed robotically”, says Dr. Jen Hoogenes, a genitourinary research fellow at St. Joe’s Urologic Cancer Centre for Research & Innovation (UCCRI). “This technology can result in safer outcomes, faster recovery times, and a lower risk of adverse events such as infection, urinary incontinence, and erectile dysfunction. Robot-assisted surgery also greatly reduces surgeon fatigue during the procedure.”

Generous donations from our community have helped St. Joseph’s Healthcare Foundation to provide funding for three robotic platforms – the da Vinci Si and its Xi successor, as well as the Mako RIO. While the new robot has arrived, St. Joe’s continues to raise funds for specialized instruments required for each procedure. Philanthropic donations and funding from the Hospital have helped to cover the costs of over 400 robotic-assisted surgeries each year, in addition to paying for the cost of purchasing and maintaining the robotic systems.

Robotic procedures performed through the Boris Family Centre for Robotic Surgery at St. Joe’s include urologic, thoracic, orthopedic, and other surgeries. With public funding, the program could be further expanded while also reducing the cost of each procedure, since robot-assisted surgery benefits massively from economies of scale.

Healthcare equity is another key issue to consider. Those living in the Hamilton region and in need of a prostatectomy benefit from St. Joe’s ability to provide this innovative technology, whereas patients in other parts of the province may not have access to robotic technology at their local hospitals.

Did you know?

Since the robotics program began in 2012, St. Joe’s surgeons have performed over 2,700 robot-assisted procedures.

The control panel of the new state-of-the-art da Vinci Xi Robotic Surgery System

Educating the World's Best

St. Joe’s is fortunate to have a dual console da Vinci system, which is used to train residents, fellows, and visiting surgeons. It also offers simulation software that can be used by learners to hone their skill in robotic surgery. The second console is a highly valuable part of our robotic and residency programs.

The alternative to a robot-assisted prostatectomy – open prostatectomy – is an older technique that is used far less commonly today in the health systems of developed nations due to higher instances of adverse events. Currently, the Ontario government will only fund open surgeries, despite widespread adoption of robotic technology in other jurisdictions. For instance, the Alberta government recently began to fund this procedure after it concluded that it would be cost-effective.

In 2017, the procedure was first considered for coverage by Health Quality Ontario, which assesses the costs and benefits of new health treatments and technologies. However, the results of its Health Technology Assessment (HTA) led to the recommendation against funding robotic technology in the province.

Yet findings from a 2020 study conducted by St. Joe’s researchers are once again making the case for public funding in Ontario. The study, published in the Canadian Urological Association Journal, found that robot-assisted radical prostatectomy could be cost-effective, aligning with findings from the Alberta government and many other jurisdictions around the world.

Surgeons demonstrate the dual console system, which offers live and simulated training.

The two-part study, led by St. Joe’s surgeon Dr. Bobby Shayegan, re-analyzed Health Quality Ontario’s HTA and performed its own in-depth analysis. Using a comprehensive dataset that included multiple randomized controlled trials, more precise estimates of annual patient volume, and a realistic 10-year time horizon (i.e., lifespan) for the robotic surgery system, St. Joe’s researchers found that the cost per procedure would be over 100 times smaller than the Ontario government had previously determined.

“We believe our findings offer a much more precise, real-world analysis of the cost-effectiveness of robot-assisted radical prostatectomy,” explains Dr. Hoogenes, who is also a co-author of the study. “We’re hoping the Ontario government will see this as an indication to revisit funding for these innovative robotic surgical systems.”

For now, St. Joseph’s Healthcare Foundation continues to raise funds for robotic surgery, allowing our Hospital to continue to provide this innovative technology to our community.

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This study was conducted by members of St. Joe’s Urologic Cancer Centre for Research & Innovation (UCCRI) and the McMaster Centre for Health Economics and Policy Analysis (CHEPA).