Just a few years ago, renowned thoracic surgeon Robert Cerfolio, M.D., was one of the biggest robotic surgery skeptics, discounting the notion that a computer-controlled system could perform a precise operation in the chest better than he could as absurd.
He is now its biggest proponent, taking a 180-degree turn.
Cerfolio, the chief of thoracic surgery for the University of Alabama at Birmingham Health Care System, has performed more robotic thoracic operations using the da Vinci Surgical System in the past four years than anyone in the world.
Robotic surgery involves tiny instruments attached to a robot remotely controlled by the surgeon at a computer board. While urologists and gynecologists have been using it for more than a decade, only in recent years have thoracic surgeons utilized it.
Robotics for Mesothelioma Patients
Cerfolio uses it to simplify the diagnostic and staging process, making it less invasive and more accurate for his patients.
“It’s about getting the diagnosis correct and treating people with small incisions and scopes,” he told Asbestos.com. “Too many surgeons will do a thoracotomy and spread the ribs of [mesothelioma] patients when they don’t need to do that.”
In March, Cerfolio lectured on robotics at the Fox Chase Cancer Center Advances in Thoracic Oncology Conference, which is aimed at medical professionals involved in the management of thoracic malignancies.
Although many established surgeons remain dedicated to Video Assisted Thoracoscopic Surgery (VATS) and open chest lung surgeries, Cerfolio is determined to convert them. The da Vinci robot can be used for wedge resections, lobectomies and lung biopsies, all of which are done on mesothelioma patients.
“I’m convinced absolutely that robotics is the way to go. My initial opinions were all wrong,” Cerfolio said. “I’ve been honest, and changed my practice. You have to be a man, and admit you were wrong. Most surgeons won’t do that. They won’t admit when they’re wrong.”
Too Many Positives to Ignore
Cerfolio, now 52, didn’t do his first robotic surgery until 2010, well after others had started. He performed more than 1,000 robotic surgeries in 2013. He is known for his robotic pulmonary resection and using robotics for esophageal surgery. Making the change wasn’t easy, particularly because he already was good at what he did. Yet, it was a chance to get better.
It was impossible to ignore the advantages of robotics:
- Improved visualization
- Less painful, quicker patient recovery
- Improved instrumentation
- More complete lymph node dissection
- Easier teaching tool
“Change is hard to do when it’s not forced upon you. I can’t tell you as a surgeon how hard or difficult that is. It’s just going out of your comfort zone,” he said. “It’s like you’re a golfer shooting 70 and winning tournaments, but now you have to go back to the driving range and learn a new grip, then shoot 80-82 for six months. The idea, though, is that eventually, you’re shooting a 66.”
Many thoracic surgeons have been slow to adopt the robotic platform. The equipment is complex and expensive, eliminating it as an option for many small medical centers. It requires not just a surgeon to embrace the technology, but an entire staff that must train alongside that doctor.
It Takes an Entire Team
“You’re a pitcher, but you’re only as good as your shortstop and second baseman,” Cerfolio said. “If your nurse is having a bad day, you’re a bad surgeon. If the anesthesiologist is struggling, you’re a bad surgeon. It requires everyone going through the same pathway.”
He believes that more study data will be released soon, providing more evidence that lung cancer patients will be better served by robotics than with VATS or open chest operations. Lymph node resections will be more complete. Survival rates will be higher. Patients will recover quicker from less painful procedures. The robotic technology is rapidly improving, too.
“It doesn’t take a rocket scientist to figure this out,” he said. “We need to do a better job of helping our patients and learning from our mistakes. Robotics can do that. It can make better surgeons. Sometimes change gets forced upon you. And you have to evolve. That helps the patient.”