Robotic thoracic surgery is an emerging technical
field. Not only does it improve the visibility- because we’re using now a 3-dimensional camera,
but we also have much more range of motion inside of the chest. We have now two arms
instead of one long instrument, and the arms have wrists that move just like my wrists
at 360 degrees. So that enables me to work inside the chest
naturally- to mimic what a thoracotomy incision would do for that patient. But the benefits
are much more far-reaching. We now have much less pain because we’re making 8 mm incisions
on the side of the patient- which certainly is much better than a 6 inch or 12 inch thoracotomy
incision. There’s much less blood loss with this technique. Patients recover much faster.
The hospital stay is much, much shorter. Their back-to-work time is also markedly reduced.
We’re now talking about 10 days to two weeks when a patient is fully recovered from one
of these operations versus four-to-six weeks from a camera operation and versus three months
or more from a traditional thoracotomy operation. We can do everything inside the chest that
you can do with any other approach, that would be a lobectomy, that would be a bi-lobectomy-
you’re taking two lobes out- a pneumonectomy- meaning that we’re removing an entire lung.
We can work on the diaphragm, if there are any diaphragm abnormalities. We can work in
the center of the chest, or do mediastinal work for tumors. We can also work with the
esophagus. The patient is positioned on their side- just
as they would be if we were going to use a camera- or if we were going to do a traditional
or an old-fashioned thoracotomy incision. We traditionally make four small incisions
in the patient’s chest. There’s an 8 mm incision for my right arm and the right arm of the
robot, there’s an 8 mm incision for my left arm which is the left arm of the robot. And
there’s an accessory incision which is 15 mm, that’s the smallest incision that we make,
it’s about half an inch- and that’s for my assistant to pass things in and out of the
chest to me. The robot is then connected to these small
ports and the instruments go through and we do the operation- where I’m sitting about
20 feet away from the patient and I’m controlling the machine- what it’s doing inside of the
chest- with controllers and a periscope that has a 3-D viewer on it.
Traditionally this is an operation that takes about two hours to perform and the recovery
is very, very quick. Most patients are up and walking that afternoon or that evening
in the hospital. If you look at the distribution of how thoracic
surgery is performed across the United States, about 68% of the surgeons who are currently
performing this type of operation do so through a thoracotomy or an open incision. About 32%
perform this with cameras routinely. And less than 1% of us across the country use a robot.
There are only a handful, i.e., perhaps five or six other surgeons in the country, that
carry the experience that I do with this particular procedure.
I’ve performed well over 300 of these operations in the last two years. So, like anything else,
the more you do it, the better you become at doing it.
This is one of the nation’s leading Thoracic Oncology programs. There are only 41 designated
NCI cancer centers in the United States. We also provide a very unique experience for
the patient that is the Thoracic Oncology Program Clinic. So when you come to see us,
you will not only see one physician, you will see four or five physicians all at the same
time. Then your particular situation- or clinical case- will be discussed at a conference that
same day. And a management plan will be developed for you based on the opinion of five or six
physicians- which we think is a better way to do things- that way you’re not running
back and forth between office visits. You’re not waiting for physicians to call you. You’re
not waiting for physicians to talk about you and come up with a treatment plan. And it’s
not disjointed at all. We have the most advanced radiation center here. We have all of the
clinical protocols here for research and gene testing. So there’s no reason that you should
be going anywhere else for your thoracic oncology care.