When a person is diagnosed with lung cancer, finding out that it is still in an early stage is very fortunate news. But the surgery that follows this news can be more daunting than the diagnosis itself--until now.
Picture a large incision spanning the side of their chest, immense pain from spreading the ribs in the fourth and fifth intercostal space, and this all while using a rib- and nerve-sparing technique. Following surgery there is one--maybe two--chest tubes in place for days, accompanied by a week-long hospital stay, maybe longer. All of this makes the "good news" seem not so good. Of course, the fact that a patient has also just increased his or her 5-year survival rate drastically, does make this slightly barbaric surgery worth it in the end. But now, with the advances in medical technology, there is a new procedure that is less invasive. I like to refer to him as the "robot."
We currently have the low-dose CT screening which offers high-risk patients the opportunity to detect lung cancer at an earlier stage, so why not offer patients a simpler surgery. Robotic-assisted thoracic surgery (RATS)--in my opinion--has truly changed the face of thoracic surgery. When comparing open thoracotomy versus RATS to perform a lobectomy, the robot is winning statistically in just about every category.
Potential patient benefits:1
- Reduced pain
- Less blood loss
- Shorter hospital stay
- Reduced time for indwelling chest tube
- Low-risk of wound infections
- Decrease in overall complication rates
- Significant reduction in mortality
All of these benefits equal a faster recovery period and an increase in quality of life for the patient. There is benefit beyond the patient as well. Due to the decrease in hospital stay, the robotic approach typically comes with less cost.1 Studies show similar long-term survival with robotic versus open thoracotomy, which has also helped oncologists get on board with this approach.1
While study data is important, I believe firsthand experience can provide a lot of insight as well.
According to one of the thoracic surgeons performing lobectomies with the robot at our facility: "Because of the limited visual capabilities when performing an open thoracotomy, the robot actually makes it possible to reach and remove more lymph node stations than before."
The thoracic surgeon has been performing lobectomies using the robot at our facility for approximately 2 years now. The average hospital stay for these patients has been 2 to 3 days. As someone who has been navigating lung cancer patients for about 8 years, the difference in improved recovery and quality of life is a complete joy to observe.
A patient who had the surgery a few months ago eagerly wanted to speak at our lung conference so he could share his outcome with the multidisciplinary team of physicians: "This was the only option for me, and I couldn’t tolerate a major surgery. I was home and back to my everyday life in no time...if an old guy like me can fly through this, anyone can. I simply feel amazing."
If a close friend or loved one ever needed to have thoracic surgery in which robotics were available, my advice would clearly be, "Use. The. Robot!" My struggle comes with the fact we also have a thoracic surgeon at our facility that is still performing the open thoracotomy procedure.
As healthcare professionals, we often get asked our opinion: "What would you do if it was your family member?" Do you share your true opinion or do you choose to take the more "politically correct" approach?
Are you familiar with the RATS procedure? If so, what has been the outcome with your lung cancer patients?
- da Vinci Surgery. (2013).Thoracic Clinical Evidence