Learning to feel . . . with your eyes
By Heather McCall
Surgeon Rajiv Singal has seen the future, and for his patients — it’s robotic.
In his almost three-decade career, Singal (MD ’90, PGME Urology ’95) has witnessed firsthand the evolution of minimally invasive technology in surgery, beginning with laparoscopy — using small incisions and a camera to aid in treating target areas — through to the latest innovations in surgery that involve complex robotics.
In popular culture, robots are pictured on a factory assembly line or running amok in a science-fiction movie. But for Singal, robots have a practical application. In robotic surgery, the surgeons sit at consoles away from the operating table and remotely control robotic arms, he explains, adding that during procedures, they remain very much in control of the surgery.
“A casual observer may think the robot is just that — a machine that’s working away, and I’m sitting in the corner and watching it. But that isn’t correct,” says Singal, a urologist, the chief of surgery at Michael Garron Hospital and an associate professor in Temerty Faculty of Medicine’s Department of Surgery.
“The robot is the evolutionary extension of a laparoscope,” he says.
Singal, who is also the director of the hospital’s robotic surgery program, uses the robot for prostate cancer surgery and plans to start using it for kidney cancer surgery later this year. He says that using robots for surgery holds immense promise — and can lead to better patient outcomes. For example, at Michael Garron, patients are not prescribed opioids after receiving robotic prostate surgery because the pain can be managed by weaker medications that pose less risk of abuse.
However, there are limitations to robotic surgery. Singal notes that the robot can’t quite replicate the sensations that surgeons experience during open surgery, of feeling tissue between their fingers. To compensate, Singal is translating years of tactile feedback to what he sees through the console.
“When you get more experience on these robotic platforms, you learn to feel with your eyes,” he says.
This lack of haptic feedback — and the challenge it presents to new surgeons during training and in their early careers — is behind Singal’s drive to create a training tool that will synthesize virtual reality and minimally invasive surgical procedures.
At a school fair in 2016, Singal was introduced to an early iteration of the technology by Ben Sainsbury, then a PhD computer science student at Ontario Tech University. The two founded Marion Surgical and immediately started developing their first product.
The Marion Surgical Simulator, introduced in 2019, allows surgeons to plan and practise laparoscopic and endoscopic procedures, such as removing kidney stones, without any risk to patients. Users don an Oculus VR headset and use a specially designed program and custom wand to virtually recreate the operating room environment and surgical situation.
Singal says that the tool can provide haptic feedback to simulate in-surgery sensations, such as the resistance of skin that a surgical trainee is puncturing to reach a kidney stone. His team at Marion Surgical is now working to apply this haptic technology to a robotic surgery simulator that will extend beyond laparoscopic procedures.
Singal expects the future of medicine will mean the use of more robotic surgery in medical settings and virtual-reality training tools in medical schools. However, he says they will never replace the need for surgeons to have more than technical skills.
“What I value most, and what we recruit, are surgeons who embrace all of the elements of what it takes to be a good doctor,” says Singal. “We need to serve the needs of patients in our community, and that starts and ends with basic care.”