Robotic Lobectomy for Lung Cancer

According to the American Cancer Society approximately 210,000 new cases of lung cancer are diagnosed in the United States each year. The overall five-year survival rate for lung cancer is approximately 15 percent. This dismal statistic is due largely to the fact that over 50 percent of patients are diagnosed when they are in stage III or IV of the disease. For those who are diagnosed when they are in stage I lung cancer, the five-year survival rate increases to 80 to 95 percent.

As most patients with early lung cancer are asymptomatic (showing no obvious symptoms), a number of researchers have advocated for CT scans for those patients who have certain risk factors for lung cancer. Although prospective studies on the effectiveness of early CT screening for lung cancer are ongoing, it is clear that in order to make an impact on an overall prognosis of lung cancer, early screening needs to be coupled with early surgical intervention.

For patients who are otherwise asymptomatic, a minimally invasive video-assisted surgical procedure for the treatment of early-stage lung cancer may be a preferred approach to removing the cancer.

Lobectomy

Surgery to remove the cancer in the affected lobe of the lung (lobectomy) is the standard of care for treatment of early-stage non small-cell lung cancer (stages I and II).

Until recently, surgery to remove either part of the lung or all of the lung involved surgeons cutting into one side of your chest in a procedure called a thoracotomy. To access the lung the surgeon would make a cut between the ribs, and all or part of the lung would be removed depending on the location, size, and type of lung cancer that is present. However, this procedure would often result in significant acute and chronic pain, as well as a long recovery.

Video Assisted Thoracic Surgery—A less invasive approach to lobectomy, through the use of Video-Assisted Thoracic Surgery (VATS) may be recommended for some patients. The VATS procedure does not require the spreading of the ribs and results in smaller incisions which could mean less post-operative pain and a shorter hospital stay.

During this procedure the surgeon makes small pencil-sized holes in the body while video equipment is used to provide a magnified view of the surgical site. Endoscopic instruments are inserted through the small incisions and used to perform the surgery. One of the shortcomings of the VATS technique, from a surgeon's perspective, is the limited maneuverability of the endoscopic instruments. Another is the lack of 3-D visualization of the surgical area.

Robotic Video Assisted Thoracic Surgery—The daVinci robot offers surgeons both 3D Visualization of the surgical field as well as more flexible instrumentation. Just as with the VATS procedure, robotic surgery does not require the spreading of the ribs and results in smaller incisions which could mean less post-operative pain and a shorter hospital stay.

During robotic surgery, the surgeon makes small pencil-sized holes in the body and inserts robotic arms. A camera is also inserted to provide a 3-D magnified view of the surgical site.

Important features of the daVinci Robot in performing VATS lobectomy:

  • Situated at the end of the robotic arm and placed through pencil sized incisions, the EndoWrist is positioned in the confined space within the chest. As compared with traditional endoscopic instruments, the EndoWrists offer the surgeon four more degrees of freedom of movement, and six additional directions of movement.
  • The daVinci Robot also scales down the surgeon's hand movements to that of the robotic instruments. This is invaluable in dissecting fine and fragile intra-thoracic structures. Furthermore, a motion filter reduces any tremor in the surgeon's hand.
  • Finally, a robotic camera provides superb 3-D visualization of the surgical site. The camera sits on a central robotic arm and can be controlled by the surgeon. This provides a natural view for the surgeon's eyes and hands and provides optimal hand-eye coordination.
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