In a Canadian first, thoracic surgeons at Toronto General Hospital, University Health Network, used a robotic surgical system to treat early-stage lung cancer by removing the cancer, along with a lobe of the lung. The use of this system improves outcomes after surgery and will expand the numbers of patients who can benefit from this type of minimally invasive surgical treatment.
In their pioneering work, a team of surgeons led by Dr. Kazuhiro Yasufuku, Director of the Interventional Thoracic Surgical Program at Toronto General Hospital (TGH), and Dr. Tom Waddell, thoracic surgeon and Head of the Division of Thoracic Surgery, performed a robotic surgery on a 78-year-old man with a tumour the size of a penny in his lung’s upper right lobe. After examining the images of the tumour, its location and assessing the potential benefit to the patient, the team decided that the best option for the patient was to use the da Vinci Surgical System to remove the cancerous portion of the lung. The surgery was performed at TGH, as part of the Princess Margaret Cancer Program.
Dr. Kazuhiro Yasufuku, Dr. Tom Waddell and Dr. Mauricio Pipkin carefully attach the first of the four robotic arms on to one of the steel ports in the patient’s chest. The robotic arms are then docked on to the four ports through which surgical instruments and camera are maneuvered by the surgeon sitting in a console with a monitor and hand controls several feet away from the patient.
“More than 70 percent of lung cancers have a good chance of being cured, if they are treated early enough, so we have brought together a team of surgeon-scientists, who use and further develop the latest technology to try and change lung cancer’s horrible statistics, “ says Dr. Yasufuku, adding that the future of treatment belongs to robotics since it can incorporate different imaging modalities which will guide surgeons to perform surgery more safely, and possibly more precisely, something that is not possible with other techniques.
Dr. Yasufuku, one of the most internationally respected thoracic surgeons with expertise in minimally invasive thoracic surgery and diagnostic procedures, was recruited from Tokyo, Japan to set up a unique Interventional Thoracic Surgical Program at TGH, which includes the development of novel technology and a surgical suite to improve the current ways of diagnosing and treating lung cancer.
Lung cancer remains the leading cause of cancer death for both men and women. More than 25,000 Canadians are diagnosed with lung cancer yearly, and more than 20,000 will die of it.
On average, 69 Canadians will be diagnosed with cancer every day, and on average, 56 Canadians will die of lung cancer every day. One in 11 men is expected to develop lung cancer during his lifetime, and one in 13 will die of it. One in 15 women is expected to develop lung cancer during her lifetime, and one in 17 is expected to die of it.
The day after his robotic surgery on October 20, 2011, Stanley Skorpid, 78, was able to get out of bed, and eat cornflakes for breakfast. On the third day, Stanley was impatiently walking the hospital hallways, and on the fifth day, he was glad to be going home. He is now back at work as a concierge, and continues to walk his German shepherd dog, Skor, about one mile to the lake close to his home.
On his second post-operative check-up today, Stanley remains cancer-free. “I’m still here,” he says happily, “I’m feeling good.”
Many centres would not consider surgery for someone of Stanley’s age, points out Dr. Yasufuku, noting that the use of the robotic system contributed to Stanley’s early recovery, along with minimal complications and pain, and a better quality of life.
Surgeons at TGH have since performed six more successful surgeries with the robotic technique on patients with lung cancer. The patients typically have shorter hospital stays, less pain, easier recoveries, less blood loss and scarring than as if they had been operated on with open-incision surgery.
During Stanley’s surgery, the surgeons made four tiny incisions in his chest between the ribs to insert a small scope and thin robotic-assisted surgical instruments. The scope provides a three-dimensional view of the chest and lungs on high-definition monitors – a magnification 10 times greater than normal vision - while the surgical tools are used to remove the cancer. The surgeon’s hands control the four robotic arms from a nearby console, and the robotic arms, in turn, translate the surgeon’s hand movements into smaller, flexible, and more precise movements of tiny instruments inside the body in real time. This precision and flexibility is especially useful in dissecting and then removing tumours as well as clearing the small bean-shaped lymph nodes located along the system of lymphatic vessels, around large blood vessels, in minimizing damage to the chest wall and surrounding tissues, and in meticulously being able to remove the smallest possible portion of the cancerous lung.
Traditionally, lung cancer resections have been done via an open incision or thoracotomy. This means that the ribs are spread apart to provide access to the chest, and this spreading of ribs and cutting of the muscle is linked to discomfort after surgery. Moreover, patients are left with a long incision on the side of the chest and a long recovery after the operation. Sometimes, minimally invasive thoracoscopic techniques are used instead, but they are limited by a standard video monitor and rigid instruments.
“We anticipate that robotic technology will provide a further improvement over videothoracoscopic minimally invasive techniques that is our current standard at UHN for early stage lung cancers," notes Dr. Yasufuku.
The da Vinci System enhances the surgeon’s technique and capability in performing complex minimally invasive surgery, such as in fine-tissue dissection and suturing. Named after Leonardo da Vinci who invented the first robot, and used anatomical accuracy and three-dimensional details to give life to his masterpieces, the system provides surgeons with similarly enhanced details.
“The robot becomes your hands, it augments what your hands can do,” explains Dr. Yasufuku. “It’s so easy for your hands to move much more finely right inside the patient. They can get in really deep. ”
To date, robotic surgery has most often been used for prostate and gynecological surgeries. It is now being used in several U.S. and European centres, and at TGH, as a useful technique in treating lung cancer. Studies in the 2011 Journal of Thoracic and Cardiovascular Surgery have shown that it is a safe procedure, and results in lower morbidity, such as blood loss, risk of infection, lower mortality, shorter hospital stays, and better quality of life than rib-and nerve-sparing thoracotomy.
In 2008, the Muzzo Family Charitable Foundation made a very generous pledge gift of $5,000,000 through the Princess Margaret Hospital Foundation to purchase the Da Vinci robot and to provide related program funding. This gift enabled the robotics program to begin and the Foundation and UHN are very grateful to the Muzzo family for their ongoing support and keen interest in the program’s development.
“We are proud to be able to contribute to such a leading edge technology with the potential to directly impact a patient’s recovery in a very difficult time,” said Marc Muzzo.
For doctors wishing to refer patients for robotic surgery consideration, please contact the University Health Network Lung Cancer Rapid Assessment and Management Program (LungRAMP): Hotline: 1- 877-Lung911 (877 586 4911) or Fax: 416 340 3353 or Email: firstname.lastname@example.org.
About Toronto General Hospital, University Health NetworkToronto General Hospital is a partner in the University Health Network, along with the Toronto Western Hospital, the Princess Margaret Hospital and the Toronto Rehabilitation Institute. These research hospitals are affiliated with the University of Toronto. Toronto General Hospital is a national and international source for research, education and patient care, and is recognized internationally for its innovations in transplantation, surgical innovation, infectious diseases, diabetes and genomic medicine.
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