Robotic
Lung Surgery
Samer A.Kanaan, MD, FACS

Robotic Lung Surgery

Lung Cancer

Lung cancer is a growth of abnormal cells inside the lung. These cells reproduce at a much faster rate than normal cells. The abnormal cells stick together and form a cluster or growth, known as a tumor. If the abnormal cells began growing in the lung, this is known as a primary lung tumor.

What are the causes of lung cancer?

  • Cigarette smoking is the major cause of lung cancer. Up to 90 per cent of cases of the disease are caused by smoking, and one in 10 smokers will develop lung cancer. The longer a person has been smoking and the more packs of cigarettes smoked per day, the greater the risk. However, it is not known why one smoker develops lung cancer while another does not.
  • Research has also demonstrated the link between passive smoking and lung cancer.
  • Workers exposed to industrial substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons and chloromethyl have a significantly high risk of developing lung cancer.

What are the types of lung cancer?

Depending on how the cells look under a microscope, cancers that begin in the lung are divided into 2 major types:

  • Non-small cell lung cancer
  • Small cell lung cancer

Non-small cell lung cancer generally spreads to other organs in the body at a slower rate than small cell lung cancer. Non-small cell lung cancer is the most common type of lung cancer, accounting for almost 80 per cent of lung cancers. Small cell lung cancer accounts for about 20 per cent of all lung cancers.

What are the symptoms of lung cancer?

Lung cancer is very difficult to detect at an early stage. Common symptoms include:

  • New or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion; and
  • Recurring episodes of lung infection, weight loss and swelling of the face or arms.

What are the treatment options?

There are various treatment options available for lung cancer (with different aims), which include: surgery; chemotherapy; radiotherapy; and laser treatment.

Those non-small cell lung cancers which are amenable to surgery are those where the cancer is confined to a lump in the lung or to the draining lymph nodes immediately next to the lump, but disease where the lymph nodes in the center of the chest are involved is usually considered not suitable for surgery alone. Investigations include chest x-rays and CT scans. Surgery may involve removal of all the lung or part of the lung. For those cancers that spread to the center of the chest, a combined treatment approach may involve chemotherapy with radiotherapy and surgery. Patients who present with widespread disease or later develop widespread non-small cell lung cancer may have chemotherapy which improves the chance of 12 months’ survival by 9%.

What is Robotic Lung Cancer Surgery?

Robotic-assisted lung surgery is a minimally invasive procedure to treat early to moderate lung cancer. Your doctor performs surgery through small incisions with the help of robotic arms that improve accuracy and dexterity.

What are the indications?

Robotic Lung Cancer Surgery is performed if:

  • Cancer has not spread far and there are no pulmonary lesions found on CT scan.
  • Cancer is still in Clinical stage 1 of lung cancer
  • Patient has no evidence of mediastinal disease or spread to the local organs

How is Robotic assisted lung surgery performed?

Lung surgery used to be performed by making a large incision over the chest, cutting through bone or spreading the ribs. However, due to advances in technology, it may now be performed in a minimally invasive manner with the help of robotic assistance.

With robotic lung surgery, your surgeon makes a few small 1 cm incisions in the rib space through which surgery such as a lobectomy can be performed, without spreading or cutting the breastbone or ribs.

Your surgeon uses the da Vinci® Surgical System, a robotic device to access the chest cavity and perform the procedure through the small incisions. The da Vinci robotic system is among the most effective and least invasive techniques for a faster recovery with minimal pain, blood loss and scarring as well as fewer risks when compared to traditional open surgery.

The da Vinci surgical system consists of a surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system (3D camera) and miniaturized EndoWrist surgical instruments.

While performing the surgical procedure, your surgeon will be seated at the da Vinci console to view a magnified, high-resolution 3D image of the area to be operated. Your surgeon would then introduce miniaturized EndoWrist instruments through the tiny incisions to access the surgical site. These instruments help your surgeon perform the procedure with precision and control. Master controls help your surgeon translate hand movements to smaller precise movements of the miniaturized instruments.

What are the benefits of robotic-assisted lung surgery?

The benefits of robotic assisted lung surgery include:

  • Less tissue trauma (no cutting or spreading ribs)
  • Less pain and bleeding
  • Better visualization
  • Better instrument control
  • Fewer complications
  • Faster recovery

Am I a candidate for robotic-assisted lung surgery?

Your doctor will take many factors into consideration including the extent of your disease and your overall health to decide whether you are a candidate for this kind of procedure.

What are the risks associated with robotic lung surgery?

Complications with robotic lung surgery are less when compared to traditional surgery but potential risks include tissue damage, lung leakage, bleeding, infection and even death. In some cases, conversion to an open surgery may be necessary.