“Pushing the Envelope” on Lung, Esophageal Surgery
Less than a decade ago, most lung cancer surgeries were major open-chest operations. In 2006, thoracic surgeons at Froedtert & The Medical College of Wisconsin began performing lung cancer procedures using video-assisted thoracic surgery (VATS).
“We can use VATS to remove a wedge of lung tissue through a single incision,” said William Tisol, MD, Medical College of Wisconsin thoracic surgeon. Patients are home within days. “Segmentectomy, lobectomy and even bilobectomy can be done using minimally invasive tools.”
“We start off assuming we can do these surgeries using a minimally invasive approach,” he said. “We push the envelope just a little as we carefully consider the best option for each patient. If we’re confident in a minimally invasive approach, we offer it.” According to Dr. Tisol, VATS is not practical for large tumors. Other possible contraindications include prior chest surgery or chest trauma.
William Tisol, MD
Dr. Tisol and colleagues also offer a minimally invasive approach to esophageal cancer. Standard surgery to remove a cancerous esophagus requires large incisions in the neck and abdomen. Medical College of Wisconsin thoracic surgeons have performed more than 60 esophagectomies using transcervical endoscopic esophageal mobilization (TEEM), a procedure that allows the surgeon to mobilize the esophagus through a small neck incision. “This is a very new approach and not widely available,” Dr. Tisol said.
What’s Next: Robotic Surgeries for Cancers in the Chest
“There has been some skepticism about using the surgical robot to operate on the chest,” Dr. Tisol said. “We chose to evaluate it on our own.” Medical College of Wisconsin thoracic surgeons have performed hundreds of robotic procedures, mainly to remove benign masses. “As robotic technology continues to improve, we will probably be able to use it for lung and maybe even esophageal cancer.”
Leader in Robotic Surgeries for Bladder, Kidney Cancers
Kenneth Jacobsohn, MD, Medical College of Wisconsin urologic surgeon and director of Minimally Invasive Urologic Surgery, is a leading provider of da Vinci robotic surgery for urologic cancers in the Midwest. He has performed more robotic kidney surgeries than any other physician in Wisconsin and more robotic bladder procedures than anyone in the region.
“Today at Froedtert & The Medical College, we use robotic tools for most kidney and bladder surgeries,” Dr. Jacobsohn said. Options include radical nephrectomy (removal of a kidney) and partial nephrectomy. “Partial nephrectomy is under-utilized in this country and in the world.”
Kidney patients who can’t have surgery can often be treated with cryoablation. “Using ultrasound or CT guidance, we insert a probe into the kidney and freeze the tumor,” Dr. Jacobsohn said.
Kenneth Jacobsohn, MD
For muscle-invasive bladder cancer, robotic instruments can remove the entire bladder. “In appropriate patients, we create a ‘neo-bladder’ using a portion of the bowel,” Dr. Jacobsohn said. “An experienced surgeon can do this safely using minimally invasive technologies.”
Minimally invasive procedures involve less blood loss and less post-operative pain. “More than 80 percent of our kidney patients treated with robotic surgery go home after just one night,” Dr. Jacobsohn said. “Our hospital stay for bladder cancer patients is shorter compared to even a year ago.”
What’s Next: Single-incision Robotic Surgery
Most robotically assisted surgeries require three to five small incisions. Advances in instrumentation may soon enable some cancer procedures to be performed through a single port. “A single-site platform is now available for non-cancer gallbladder surgery,” Dr. Jacobsohn said. “The technology needs to evolve more, but we hope the Food and Drug Administration will approve it for cancer surgeries.”
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