Robotic surgery opens new treatment option for lung cancer

April 14, 2016 Providence Health Team

Lung cancers usually aren’t discovered until they’ve spread and caused symptoms, and by then it’s often too late for a cure. Cancers that are detected before they’ve spread are often discovered by accident. That’s what happened to Julie Filer.

Julie visited a walk-in clinic in Everett, Wash., last September for an unrelated issue and had a chest X-ray. While reviewing the image, the attending physician noticed a spot, nearly three-quarters of an inch in diameter, in the lower lobe of Julie’s left lung. She pulled an older, 2009 X-ray from Julie’s file for comparison, and there it was – smaller back then, but in the same place. The nodule had been growing in Julie’s lung, slowly and silently, for at least seven years.

A rare lung cancer

Several scans and a biopsy later, Julie had a name for the nodule: neuroendocrine carcinoid, a malignant, slow-growing form of cancer that’s unrelated to smoking. This cancer more commonly occurs in other parts of the body, such as the GI tract. Only 1 to 2 percent of all cancers in the lung are carcinoids.

“I was dumbfounded,” says Julie, who is in her 60s. “I’ve always been healthy. I’m a big walker –  I’d been walking 5-6 miles every day. I wasn’t short of breath. I wasn’t coughing. Nothing. There were no symptoms whatsoever.”

A ‘patient and kind’ doctor explains

Treating her cancer, she was told, would require a lobectomy – removal of the lobe of the lung that contained the cancer. Julie was referred to thoracic surgeon Luis Alberton, M.D. at Providence Medical Group Everett. “I was extremely nervous,” says Julie, “because I don’t do well with unknowns.”

In addition to all of the unknowns surrounding the surgery itself, Julie, a first-grade teacher in Snohomish, was concerned about how long she would have to be away from her students.

 “I asked Dr. Alberton, ‘Can this wait until June?’ He was so patient and kind,” says Julie. “He sat me down and said, ‘I’m going to treat you as if you were my relative, and the answer is no. This tumor has been there for a while. It hasn’t spread, but it’s growing. We need to take care of it.’”

Advancements in thoracic surgery

Dr. Alberton explained that he could offer her a new type of surgery that would minimize her recovery time and help her return to the classroom as soon as possible. He had just recently joined Providence to help launch a new robotic thoracic surgery program at Providence Regional Medical Center Everett, a tertiary care center located 20 miles north of Seattle.

The hospital has used the da Vinci Xi robotic surgery system for gynecology, urology and general surgery for some time; thoracic surgery is one of the newest applications for the technology.

Three choices

Dr. Alberton laid out Julie’s options:

  1. Traditional open lobectomy requires a large incision and spreading the ribs to reach the lung. While about 70 percent of thoracic surgeons in the US still do open surgery, says Dr. Alberton, the traditional approach is falling out of favor where minimally invasive techniques are an option.
  2. Video-assisted thoracic surgery, or VATS, involves operating through smaller incisions between the ribs, using an internal camera to view the surgical area. The less-invasive technique makes recovery easier and faster.
  3. Robotic surgery, the newest advancement, combines the advantages of small incisions with robotic precision, enhanced vision and improved dexterity. Early studies suggest that robotic surgery may result in less pain and a faster return to normal activities than either open surgery or VATS. Currently, less than 5 percent of thoracic surgeries in the US are done robotically, says Dr. Alberton, but that’s growing as more surgeons become trained and the advantages become clear.

Easier recovery a deciding factor

Based on his experience with all three approaches, including more than 100 robotic cases during his training, Dr. Alberton believes that robotic surgery is the best option for patients. The console displays the surgical field in three dimensions with up to 10 times the magnification, compared with the 2-D display of VATS.

In addition, says Dr. Alberton, “Any motion I can do with my hands, the robot can simulate inside the patient. With VATS, you can’t rotate with the same freedom. Since you can see better and move your hands better, there is less bleeding. It all works together for a better operation that’s easier on the patient.”

The choice was Julie’s. Before making her decision, she sought a second opinion at University of Washington Hospital, where her daughter works. “They offered VATS, but couldn’t offer robotic,” says Julie. The easier recovery with robotic surgery helped sway her, but the deciding factor, she says, was her confidence in her surgeon. “Dr. Alberton communicated really well and gave me a firm understanding of what was going to happen,” she says. “I just felt comfortable with him.”

The best of man and machine

On Dec. 3, 2015, Julie became the first person to have a robotic lobectomy at Providence Regional Medical Center Everett.

During the 2½-hour procedure, Dr. Alberton sat at the console, his thumbs and middle fingers strapped into finger loops that conveyed his movements to the robotic surgical instruments. Thoracic surgeon Kimberly Costas, M.D. assisted at Julie’s bedside. Everything went perfectly.

Just two days after having the lower lobe of her lung and her lymph nodes removed, Julie went home. Within a week, she felt good enough to stop using pain medication; “I didn’t even take Tylenol after that,” she says.

Precision for complex surgery

After another week, she was back to her normal activities, and by Christmas she was walking around her neighborhood again. Julie returned to teaching on Jan. 14, cancer-free, with no need for chemotherapy or radiation therapy.

Today, says Julie, “I feel great! I’m back to everything I used to do, and I’m very grateful for the team at Providence.”

As the use of robotic technology becomes more common, quality care will depend on the skill and experience of the men and women behind the machine. Drs. Alberton and Costas plan to create a thoracic robotic surgery center of excellence where they will train other surgeons and contribute to outcomes data. Robotic technology offers the precision for even the most complex thoracic procedures, including:

  • Lobectomy (removal of a section of the lung called the lobe)
  • Wedge resection and segmentectomy (removal of a small part of lung tissue that contains cancer)
  • Thymectomy (removal of the thymus gland for tumor or myasthenia gravis)
  • Esophagectomy (removal of the esophagus for cancer or other disease)
  • Repair of hiatal and paraesophageal hernias (for patients with reflux disease and regurgitation)
  • Lymph node removal

“We both feel that it’s a significant advancement in thoracic surgery,” says Dr. Costas.

Providence offers da Vinci robotic surgery in Washington, Alaska, Oregon, Montana and California, with a growing number of hospitals specifically offering it for thoracic surgery. Ask your provider for more information, or find a Providence doctor in your area.

Previous Article
Sleep deprivation could lead to risky teen behavior
Sleep deprivation could lead to risky teen behavior

Is your teen constantly dragging? If so, he or she is not alone. Most teenagers in the U.S. suffer from sle...

Next Article
Sugar addiction: Similar to drug abuse?
Sugar addiction: Similar to drug abuse?

Researchers in Australia say that high sugar consumption increases dopamine levels in a way similar to addi...