Robotic Lung Surgery
With a new lease on life following robotic lung surgery, Ted West enjoys spending time in his woodworking shop.
In early 2012, Ted West, a 71-year-old former smoker, was diagnosed with lung cancer. The year before, he had developed a persistent cough; and when it didn’t go away, his family doctor sent him to James Murphy, MD, a pulmonologist. Tests showed Ted had a lesion on his right lung.
Lesions on lungs are common and often present no medical harm, but over time, follow-up imaging gave Dr. Murphy cause for concern. Biopsies initially indicated the spot was benign; but, when the lesion began to take on a suspicious appearance, Dr. Murphy decided it needed a closer look.
That’s when Dr. Murphy referred his apprehensive patient to Jose Rodriguez, MD, director of cardiothoracic robotic surgery at Miami Valley Hospital. As one of the area’s first surgeons to perform robotic thoracic (chest) surgery, Dr. Rodriguez knew if Ted’s spot turned out to be cancer, he could remove it with less pain and scarring than Ted feared.
“He told me he thought he could fix me, and I told him I was willing to put my life in his hands,” Ted said.
Ted had never heard of robotic surgery before he met with Dr. Rodriguez.
Ted’s anxiety soon turned to relief as Dr. Rodriguez told him about a new minimally-invasive surgery performed with the da Vinci Surgical System.
With da Vinci, tiny mechanical arms are inserted into the patient through five small incisions. The surgeon controls the movements of the da Vinci’s robotic arms through controls at a console several feet away from the operating table. The robot translates the surgeon’s hand, wrist and finger movements at the control console into corresponding micro-movements of the instrument tip. Similar movements also control a camera to see inside the patient’s body.
Not all patients are candidates for robotic lung surgery. There are tumor size and location considerations. Usually, Stage I and II cancer patients benefit from robotic surgery, which is why Dr. Rodriguez presented it to Ted as a possible option.
Dr. Rodriguez’s plan was to perform a biopsy and then immediately proceed with robotic surgery if cancer were revealed. Dr. Rodriguez used another method – video-assisted thoracic surgery, or VATS – to perform a biopsy of Ted’s lung; and when cancer cells were identified, he immediately switched to the da Vinci System to remove the entire lower lobe of Ted’s right lung.
The removal of the lobe, known as pulmonary lobectomy, is one of the most common surgical treatments for lung cancer. Traditional thoracotomy (cutting into the chest wall) and lobectomy require a large incision, often ten inches. This surgery also commonly results in substantial blood loss and a lengthy and uncomfortable recovery. Ted’s minimally-invasive surgery took two hours during which time Dr. Rodriguez removed Ted’s entire lower lobe through a one-and-a-half inch incision.
Ted was amazed at his condition when he woke up in recovery. Five days after undergoing surgery he was headed home. (Some patients can go home as early as three days after a robotic pulmonary lobectomy.) In comparison, patients who undergo traditional lung surgery stay for an average of seven days.
“I never saw one drop of blood through the whole experience,” Ted recalls. “I never had bleeding where the holes were. All I had were little scabs where the incisions were, and about six weeks later they were gone.”
As Ted discovered, robotic surgery delivers significant benefits to patients including shorter hospital stays, less pain, reduced risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities.
The da Vinci allows physicians improved access to operative areas and enhanced visualization. It gives surgeons high-definition three-dimensional vision and allows magnification of the surgical area by a factor of ten times. And because the da Vinci is a robot, physicians are able to perform surgery with the same precision each and every time – something that is not possible with traditional surgery.
Dr. Rodriguez, who joined Premier Health Specialists and Cardiothoracic Surgery Associates in Dec. 2011, brought with him extensive experience in robotic lung surgery. Today, MVH is among approximately 200 hospitals across the nation with experienced robotic thoracic surgeons on staff.
Up until 18 months ago, Dr. Rodriguez used VATS to perform most of his lung surgeries. Now he mainly uses the da Vinci System. However, he still uses VATS, as in Ted’s case, to perform initial biopsies.
Getting the Word Out
Dr. Rodriguez hopes to educate the public on the advantages of robotic surgery so they can make an informed decision when facing surgery. Many local physicians who are aware of the da Vinci’s capabilities refer their thoracic patients to Dr. Rodriguez. Such was the case with Mary Roden-Borton.
The 76-year-old cancer survivor lives in Quaker City, Ohio, but when follow-up imaging indicated the disease was back, her family didn’t hesitate to bring her to MVH for evaluation. At first, the cancer spot on Mary’s lung was diagnosed as Stage I, but through the advanced visualization of the da Vinci, Dr. Rodriguez accurately upstaged Mary’s case to Stage III.
With the da Vinci, Dr. Rodriguez found a cancerous lymph node that wasn’t detected on an earlier PET scan and might have been missed with VATS. While the diagnosis was not what Mary and her family had hoped, it has allowed her oncologists to create a more accurate treatment plan. And the minimally-invasive procedure left her in better physical shape for the cancer therapy to follow.
“The next morning (after the surgery) I was up and eating and walking and I did real well,” Mary said. “I expected to be a lot worse.”
Not long after returning to her daughter’s Dayton home, Mary was back to her normal activities. Perhaps most important, she was able to attend some of her grandchildren’s graduation celebrations this spring.
Back to Normal
Ted has returned to normal life after his Feb. 25 surgery. Because his tumor and the surrounding lobe were removed, he did not have to undergo chemotherapy or radiation. He realizes he’s one of the fortunate ones whose lung cancer was detected early.
Early detection is important. More people die from lung cancer than from any other type of cancer, according to the Centers for Disease Control and Prevention. But only 30 percent of lung cancer is treatable with surgery.
According to the American Cancer Association, there are 400,000 lung
cancer survivors. Ted is pleased to be among them.
Today, Ted is back to his monthly breakfast dates with his former Regional Transit Authority colleagues. It’s a ritual he has been a part of since he retired from his 33-year-career as an RTA bus driver in 2001.
This summer he has enjoyed sitting on the front porch of his Dayton home with his wife Sandy watching the world go by. Come fall, he’s looking forward to spending time in his basement woodworking shop.
He doesn’t take his outcome for granted. “I feel pretty lucky I’m still here,” he said.
Robotic Surgery at MVH
Miami Valley Hospital was the first to perform robotic surgery in the Dayton area and since then has rapidly become one of the state’s leaders in the field.
Ted and wife Sandy, now in the second decade of their retirement, are looking forward to more years together.
MVH introduced robotic surgery in 2006 when the first prostatectomy – removal of the prostate for cancer – was performed at its downtown location. To date, surgeons at MVH have completed more than 3,000 robotic surgery procedures, using one of the hospital’s four da Vinci Surgical Systems. Surgeons use the systems to perform minimally-invasive surgeries in urology, gynecology, cardiothoracic, general surgery, nephrology (kidney), and bariatrics.
MVH remains the area’s leader in robotic surgery. It is currently ranked first in the state in the number of gynecological and rectal cancer procedures performed. And the hospital is fifth in Ohio in terms of total robotic surgery procedures completed.
Patients come to MVH from all over the state because of this reputation. So do physicians. Thoracic surgeons throughout Ohio have come to MVH to observe Dr.Rodriguez’s cases.
Moreover, said Robert Bowman, vice president of hospital operations, “Physicians from around the country refer patients to MVH to have partial kidney nephrectomies because Erik Weise, MD, is seen as a national frontrunner in the procedure.”
Robotic surgery is constantly evolving. For example, surgeons at MVH now use FireFly infrared technology in conjunction with the da Vinci Surgical System to light up cancer cells, thereby distinguishing them from healthy organ tissue.
As robotic surgery continues to advance, MVH plans to stay a leader in this technology.