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Summa procedure means less pain, fewer infections and quicker recovery time in some lung cancer cases
By Cheryl Powell
Beacon Journal medical writer
Published on Monday, Jan 12, 2009
Summa Health System recently became one of several hospitals nationwide offering a robotic procedure to remove an entire cancerous lobe of a lung for some patients with early-stage lung cancer.
The less invasive version of the lung surgery allows doctors to operate through small incisions rather than using openings as large as 10 inches to expose the chest cavity.
For those who qualify, the less-invasive option means less pain, fewer infections and quicker recovery, which allows patients to leave the hospital and potentially start curative chemotherapy and radiation treatments faster if needed, said Dr. Eric Espinal, a cardiothoracic surgeon at Summa.
Espinal estimates the recovery time for the robotic procedure is about three to four weeks, compared with eight to 12 weeks for the open-chest approach.
''Clearly, people want to get back to their lives,'' said Dr. R. Douglas Trochelman, Summa's medical director of oncology. ''And, clearly, I don't have to wait as long to start post-op therapy.''
The robotic version could also save money.
Although the instruments for the robotic procedure cost several hundred dollars more than for the traditional open-chest surgery, the post-operative costs are expected to be lower because of shorter hospital stays and fewer complications, Espinal said.
Lung surgery is the latest procedure being offered using the robotic technology. Summa and other hospitals throughout the region also are offering less-invasive, robotic-assisted surgeries for cardiac, prostate and gynecological problems.
First patient
In November, Nancy Schwartz became the first patient to undergo the new lung procedure — known as a robotic lobectomy — at Summa's Akron City Hospital campus.
Schwartz, 65, of Brimfield Township, was diagnosed with early-stage lung cancer in the fall after tests confirmed she had a 3-centimeter tumor in her left lung.
Both her parents died from lung cancer.
But Espinal quickly eased Schwartz's worries after her diagnosis, telling her, ''Today, we can do so much more.''
During the procedure, Espinal sat at a high-tech control panel near Schwartz's bed and manipulated the hospital's da Vinci Surgical System to remove a cantaloupe-sized lobe of her lung through a 31/2-inch incision.
While watching a video screen with magnified, 3-D images captured inside Schwartz's chest cavity, Espinal directed the machine's three mechanical arms to staple off blood vessels and remove the lung lobe with the tumor.
Schwartz left the hospital after six days and was able to decorate her home and host family members for the holidays. She didn't require any post-operative rehabilitation or treatments.
''Within a month, I was where I would have been after three months with the other surgery,'' she said. ''I just think it's fantastic.''
For now at least, the robotic-assisted lobe removal is limited to otherwise healthy patients with well-defined tumors that are not attached to the chest wall.
Currently, only about 25 percent of lung cancer patients are in the early stages of the disease and therefore eligible for any type of surgical cure when they're diagnosed, Trochelman said.
But eventually, Espinal said, surgeons might be able to offer the robotic surgery to more early-stage lung-cancer patients who currently aren't eligible for curative operations because they have other health problems that make the procedure too risky.
''The population of patients who have lung tumors a lot of times have emphysema and you're concerned about putting them through a big surgery,'' he said.
Growing need
The need for lung cancer treatment options is great nationwide and expected to grow as the population ages.
Lung cancer is the leading cause of cancer fatalities in the United States, accounting for almost 162,000 deaths each year, according to the American Cancer Society.
The society estimates more than 215,000 Americans were diagnosed with lung cancer last year.
Summa and at least several other Northeast Ohio hospitals — including Akron General Medical Center, the Cleveland Clinic and University Hospitals Case Medical Center (UH) in Cleveland — already have been offering another less-invasive approach to remove cancerous lobes in lungs when appropriate.
The video-assisted thoracic surgery, also known as a thoroscopic lobectomy, uses three 1-inch incisions and one 3- to 4-inch incision to access the chest cavity and lungs without spreading the ribs, according to the Cleveland Clinic.
A tiny video camera called a ''thoroscope'' is used along with special instruments to allow the surgeon to see inside the chest cavity without opening the chest through a large, 8-inch incision that's often required during traditional open chest surgery.
Akron General, UH and the Cleveland hospitals have the same robotic surgical system as Summa but are not using it for lung lobe removal at this time.
Akron General's cardiac and thoracic surgeons will be pursuing more training this year to offer more robotic procedures, said Gary Tomcho, the hospital's vice president of surgical and support services.
Dr. David Mason, a thoracic surgeon at the Cleveland Clinic, said in a prepared statement the Clinic is not using robotics for the lung procedure. '' . . . But we are finding great success using our video assisted approach, using small incisions and shortening the recovery time for the patient.''
A University Hospitals spokesperson said the video-assisted thoracic surgery has all the same benefits as the robotic version — tiny incisions, quicker recovery time and more accuracy.
But Espinal asserts that the robotic version offers the surgeon ''additional dexterity'' to maneuver around the chest cavity and its blood vessels.
With any less-invasive approach, however, the surgeon always has to be prepared to switch to the traditional, open-chest approach during the procedure if needed.
''You have to be prepared to convert to a larger incision,'' Espinal said. ''Our goal is to achieve a successful operation.''
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Get the full article here.
Comments
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Akron, , OH
Posted 07:23 AM, 01/12/2009
It's amazing the body parts that can be removed by doctors.
Posted 10:23 AM, 01/12/2009
Thats really amazing!! Dr. Espinal is a great doctor!! Its been said once they cut you open, the cancer is more likely to spread through your entire body.
Akron, Oh
Posted 07:32 PM, 01/12/2009
Dr Espinal is great doctor! I had him in 2001 without the robot, he is also a great person.
