At the vast majority of hospitals, lung cancer surgeries are performed
using an open thoracotomy. A procedure first performed in 1912, it remains
the technique used today in the United States — resulting in a large
incision and a hospital stay of seven to 14 days.
St. Jude is one of a small number of hospitals with the expertise and technology
to create a very different scenario, where lung cancer is removed through
tiny incisions, creating better outcomes, fewer complications, less pain
and a much shorter hospital stay.
Using the da Vinci Surgical Robotic System, our surgeons are creating the
next generation of minimally-invasive surgeries in areas from gynecology
and urology to the treatment of lung and colon cancers.
UNPRECEDENTED PRECISION AND ACCURACY
“Long-term survival rates after lung cancer surgery have not improved
in decades,” explains Daniel Oh, MD, Harvard-trained thoracic surgeon,
and one of the first in the state — and nation — to routinely
perform robotic lung cancer removal. “Robotic surgery is allowing
us to finally change that, by giving us the tools to more completely and
aggressively remove the cancer.”
Inside the hospital’s state-of-the-art surgery suites, the da Vinci’s
robotic and computer technologies scale, filter and seamlessly translate
a surgeon’s hand movements into smaller, more precise movements.
Inserted through very small incisions, the robotic “wrists”
hold miniaturized instruments and a high-definition 3D camera offering
magnified views of the surgical field.
“The ability of the robotic wrists to bend and rotate far exceeds
that of a human hand, allowing us to perform complex and highly controlled
motions that would otherwise be impossible,” says Dr. Oh, medical
director of the St. Jude Center for Thoracic and Esophageal Diseases and
assistant professor of surgery at Keck School of Medicine of USC. “The
outcome is more significant than simply making surgeries less invasive:
we are creating a more precise and successful cancer treatment.”
IMPROVING SURGERY FOR WOMEN
Pelvic-organ prolapse — in which the ligaments supporting the uterus
and bladder weaken — affects almost 50 percent of women. Once only
correctable through a large abdominal incision, Melanie Santos, MD, a
fellowship-trained, board-certified urogynecologist at St. Jude, now almost
exclusively uses a robotic procedure to secure a thin mesh in place. The
procedure is performed through a few small incisions, allowing patients
to often go home the very next day.
“Telling women this is fixable — and we can do it in a way
that allows you to recover quickly, heal faster, and experience less pain
— that is encouraging more and more women to not simply live with
it anymore,” explains the Stanford-trained surgeon.
“Robotic surgery allows a precision that isn’t possible through
other techniques — which means a less invasive procedure, better
recovery and higher quality of life for patients,” explains Thomas
Hughes, MD, a UCLA-trained, board-certified gynecologist who uses a robotic
approach for hysterectomies as well as the treatment of uterine fibroids.
“Because there is significantly less blood loss and trauma to the
tissue, surgeries that might normally require three to four days in the
hospital, are now becoming same-day procedures.”
FROM COLON TO GALLBLADDER SURGERY
In addition to all the usual benefits of robotic-assisted surgery, Theodoros
Daskalakis, MD, a board-certified general surgeon who specializes in robotic
surgeries, is adding one more. He routinely performs gallbladder surgery
through a single incision across the belly button, offering patients an
almost scarless procedure. “Robotic surgery is dramatically reducing
the emotional and physical impact of surgery for patients,” he explains,
adding that the number of procedures performed with a robot will continue
to increase. “This is the future.”
Dr. Daskalakis is also using the da Vinci robot to perform hernia repair
and remove diseased sections of the colon through dime-sized incisions.
The robot’s Firefly Fluorescence Imaging capabilities — in
which a dye is injected allowing the surgeon to clearly visualize anatomy
and blood flow through a fluorescent camera — is proving valuable
in minimizing the risk of complications. “Firefly allows me to identify
potential issues before completing the surgery,” he says, “an
advantage not possible with traditional surgery.”
ROBOTIC PROSTATE REMOVAL — WHERE IT ALL BEGAN
Six years ago, Michael Gazzaniga, MD, a board-certified urologist, performed
the first robotic procedure at St. Jude — a robotic prostatectomy
— a surgery which has since become the gold standard for the treatment
of prostate cancer.
“Robotic prostatectomy demonstrates that, through a few small incisions,
we can maximize cancer removal while creating substantially less pain,
shorter recovery, and fewer risks of long-term side effects such as incontinence,”
explains Dr. Gazzaniga.
The robotic approach offers better visualization and access, allowing surgeons
to more successfully avoid the nerves, blood vessels and muscles that
control function. Research suggests that robotic-assisted prostate surgery
is also less likely to leave cancer cells at the edges of the tumor sites,
reducing the need for additional cancer treatments, such as radiation.
“Robot-assisted surgery has significantly changed what we can offer
patients in terms of safety and outcomes,” Dr. Gazzaniga says. “And
this is just the beginning.”
A PASSION FOR PATIENT CARE
The price tag for the technology used in robotic surgery is not small.
When surgeons at St. Jude first began pursuing a robotics program, generous
donors within the community came forward to purchase the $2 million da
Vinci Surgical Robotic System.
Since then, the program has grown into one of superior expertise and success.
“What is uncommon about this hospital is the commitment found here,”
Dr. Oh explains, who proctors and trains surgeons from around the world
on performing robotic lung cancer removal. “Anyone can purchase
the technology — using it to meaningfully advance patient care is
a much higher standard.”