Thoracic surgeon Jason Long, MD, MPH, is one of just a few such surgeons in North Carolina using a robot to operate on lung cancer.
Robot-assisted surgery has long been a feature of urology and gynecology at UNC Health Care, but recently the use of the da Vinci robot has widened into other specialties.
Dr. Long, assistant professor of cardiothoracic surgery and co-director of the UNC Lung Cancer Screening Clinic, says the machine’s range of motion and 3-D high-definition imaging make it an ideal tool for operating in the chest.
Robot-assisted surgery is part of a broader effort to help patients to faster, more effective and more comfortable recoveries.
Robot-assisted surgery is part of a broader effort to help patients to faster, more effective and more comfortable recoveries. The UNC Enhanced Recovery Program consists of interventions performed on and by patients before and after surgery to improve results.
Advantages of a Minimally Invasive Approach
Whenever possible, a minimally invasive approach is always preferable for thoracic surgery patients, Dr. Long says. In that case, the options are to use the da Vinci machine or VATS, video-assisted thoracoscopic surgery. These approaches both involve making small incisions, through which a scope and other instruments are inserted; the scope allows surgeons to see the tissue they are working on and the robotically driven instruments they are remotely guiding.
“With either the robot or VATS, it’s been shown time and again that these approaches that involve small incisions are better than making a big incision (thoracotomy), spreading the ribs open and doing, for example, a lung cancer operation,” Dr. Long says.
With either the robot or VATS, the trauma inflicted on the body during a major thoracic procedure can be greatly reduced.
With either the robot or VATS, the trauma inflicted on the body during a major thoracic procedure can be greatly reduced. And that is, of course, advantageous for the patient.
“With these kinds of procedures, there is less pain, less bleeding, quicker recovery and patients are out of the hospital quicker,” Dr. Long says.
The robot may have a slight edge over VATS, he adds.
“With the robot, you have greater freedom of movement with the instruments, the instruments are powered by much better energy sources and the 3-D/HD camera makes it much easier to get in there and dissect things. You get much better lymph node dissections with the robot than you can with VATS.”
What the Robot Can Do
The robot can be used for basically any procedure that can be done open.
“In fact, in a lot of cases the robot can make procedures easier: The chest is a small, confined space, and with the robot, all of a sudden you have these instruments that can do all these other movements that you wouldn’t otherwise be able to do,” Dr. Long says.
“We use the robot for a majority of our lung cancer operations, including lobectomies and segmentectomies. We use it for anterior and posterior mediastinal masses. A robotic thymectomy, in particular, is much easier to perform as compared to a VATS approach and much less morbid than a sternotomy. The robot also greatly facilitates performance of anti-reflux operations as well as repair of paraesophageal and hiatal hernias.”
The next goal is to expand the use of the robot to esophagectomy. A major benefit is that virtually anyone is a candidate for the technique; physique doesn’t matter.
The UNC Enhanced Recovery Program
In addition to his work with the robot, Dr. Long is the physician champion for the thoracic division for the UNC Enhanced Recovery Program, which is run by the Department of Anesthesiology. The program involves interventions before and after surgery designed to help with pain control and get patients discharged more quickly.
“It’s worked brilliantly with the robot,” Dr. Long says. “Our average length of stay for a lung cancer operation is about four or five nights, but I’ve had several people in the Enhanced Recovery Program that have been discharged after two nights in the hospital.”
Before a procedure such as a lobectomy, patients will be given a spirometer to use at home. The spirometer helps them practice taking deep breaths and coughing, to help them do what they need to do to leave the hospital without pneumonia. Deep breathing and productive coughing in the days after surgery can help keep the lungs clear, thereby reducing the risk of infection.
This means patients are taking fewer narcotics, leaving them less sleepy and better able to get out of bed and walk around.
Patients are also put on multimodal pain medications starting the day of the surgery and continuing after the procedure. This means patients are taking fewer narcotics, leaving them less sleepy and better able to get out of bed and walk around.
“The program is really a lot of different things that, when put together, get patients out of the hospital sooner,” Dr. Long says. “We are one of the few places in North Carolina that are doing robotically assisted thoracic surgery. Together with the Enhanced Recovery Program, that makes UNC uniquely well-equipped for lung cancer surgeries and other thoracic procedures.”
Jason Long, MD, MPH, is a thoracic surgeon who practices at UNC Cardiac and Thoracic Surgery Clinics and UNC Hospitals Jason Ray Transplant Clinic. He is an assistant professor in the UNC School of Medicine.