09:07am Sunday 20 October 2019

Robotic Surgery at AGH Offers Patients With Early Stage Lung Cancer a New, Less Invasive Treatment

Robotic Lung SurgerySurgeons at AGH now join a select group across the country using robotics to perform sophisticated lung cancer operations through much smaller incisions that not only shorten recovery times and cause less pain, but may also lead to better outcomes.
AGH thoracic surgeons Richard Maley, MD, Lana Schumacher, MD, and Mathew VanDeusen, MD, performed the hospital’s first robotic lung cancer surgeries in September, and the group expects to treat a growing number of patients with the advanced procedure.
Lung cancer is the leading cause of cancer-related deaths among both men and women in the United States. Of the nearly 250,000 people diagnosed with the disease each year, approximately 20% have the earliest and most treatable stage – where the cancer is isolated in one section of the lung. A recent study in the New England Journal of Medicine showed that those diagnosed with Stage I lung cancer and treated promptly have a 10-year survival of close to 90%.
Across the country, the conventional treatment for early stage lung cancer involves removing the diseased section of the lung through a six to ten inch chest incision. The technique – called a thoracotomy lobectomy – can be quite painful post-operatively because it entails cutting through muscle and spreading the ribs to operate on the lung.   At more specialized centers, such as AGH, surgeons have also performed video-assisted thoracic surgery (VATS) for some time using more traditional hand-held laparoscopic tools, although the difficulty of this approach has occasionally limited its availability to patients.
Robotic lung surgery is a closed-chest procedure that is performed using the da Vinci Surgical System, a highly advanced technology that allows surgeons to resect lung tissue through just a few small incisions.
Originally developed by NASA for operating remotely on astronauts in space and used by the Department of Defense to operate on soldiers in the battlefield, the da Vinci System is comprised of two primary components, a remote console that accommodates the surgeon and a five armed robot that is positioned at the patient’s side. 
Sitting comfortably at the console several feet away from the operating room table, the surgeon maneuvers da Vinci’s robotic arms and views the surgical field in high magnification and resolution through a three dimensional endoscopic camera. The System seamlessly and precisely translates the surgeon’s natural hand, wrist and finger movements from controls at the console to the robotic surgical instruments inside the body.
 “Robotic technology takes the potential of less invasive surgery for lung cancer to a whole new level, opening this option up to a much broader segment of our patients. The robotic system dramatically enhances visualization of the operative site and more precisely mimics the complex movements of the hand and wrist, allowing us to delicately access the lung and remove the cancerous section,” Dr. Schumacher said.         
As a result, patients undergoing the new procedure recover faster, experiencing less pain, blood loss and scarring than those treated by conventional means.   Such advantages may also translate into better long-term outcomes, said Dr. VanDeusen.
“Pain following surgery can cause significant complications for patients, including an increased risk of pneumonia if patients find it difficult to cough and clear their lungs of secretions, and the potential delay of important adjuvant cancer treatments, such as chemotherapy, that many patients require” he said.
Most any patient diagnosed with Stage I lung cancer is considered a candidate for robotic-assisted lobectomy, but the procedure has particular promise for patients who are compromised by other medical problems and who may not be able to undergo a more invasive operation.
According to George Magovern, MD, Chair of Thoracic and Cardiovascular Surgery at both AGH and the West Penn Allegheny Health System, adding lung surgery to AGH’s robotic capabilities is yet another example of the hospital’s leading expertise in the management of complex medical disorders.  
 “Some of the most groundbreaking surgical innovations of our time are being advanced with the assistance of robotic technology that can significantly enhance a surgeon’s ability to perform complicated, minimally invasive procedures with unprecedented precision and effectiveness. Allegheny General has emerged not only as the region’s leading center of expertise in this unique capability, but it now also ranks among the most comprehensive robotic surgery programs in the country,” Dr. Magovern said.
For more than a decade, surgeons at AGH and West Penn Allegheny have been at the forefront of using robotics to perform minimally invasive gynecologic procedures and urological surgery, such as for prostate cancer.   More recently, doctors at the hospital also became the first in Pittsburgh to perform robotic-assisted donor nephrectomy – or the removal of a kidney from a live donor for transplantation. Currently just a handful of transplant centers nationwide offer this less invasive option to organ donors. 
AGH’s thoracic surgery team is also using the robotic system to perform less invasive esophageal surgery, resection of other mediastinal (chest cavity) masses and thymus gland removal. 
AGH is the only hospital in western Pennsylvania that performs robotic minimally invasive surgery across the five major disciplines of gynecologic, urologic, cardiovascular, thoracic and transplantation surgery.   
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