The “I’m going to Disney World” proclamation popularized by Super Bowl champions and Most Valuable Player award winners might soon be associated with another small but select group, mesothelioma survivors.
Dr. Farid Gharagozloo, one of the nation’s most innovative thoracic surgeons, recently joined Florida Hospital Celebration Health, located in the Walt Disney World-planned community of Celebration. He believes his success with robotic surgery can change the way malignant pleural mesothelioma is treated today.
“The patients coming here should get a Disneyesque experience. Not a fantasy one, but a real one, with the best care available anywhere. It’s like being in a Ritz Carlton,” Gharagozloo told Asbestos.com. “Mesothelioma has been treated in the past with a simplistic approach. We hope to change that. We came here to do something big, to make a difference.”
Doctors at the resort-like Florida Hospital Celebration Health perform approximately 2,000 robotic surgeries annually, more than any other hospital in the U.S.
Its Global Robotics Institute is a pioneer in minimally invasive urological and gynecological cancer treatment, providing groundbreaking health care with clinical innovation.
Gharagozloo was named its chief of cardiothoracic surgery earlier this year, bringing a new dimension to the robotics institute with his expertise in pleural mesothelioma, lung and esophageal cancers.
Gharagozloo Broke New Ground in Arizona
He came from the University of Arizona Cancer Center in Tucson, where in 2013 he became the first doctor in the U.S. to use robotic surgery to help perform an aggressive extrapleural pneumonectomy (EPP) for a mesothelioma patient. He performed 10 EPPs from January of 2013 to November of 2014.
All 10 patients are alive and doing well today, creating a promising success rate for this rare and aggressive cancer that carries a typical life expectancy of six to 18 months.
“I came here because it really is the right marriage for the way I do medicine. It was a chance to do something special,” Gharagozloo said. “We decided a couple years ago that our experience with the robot was extensive enough to apply it to mesothelioma. Robotics can change the way we view this very complex disease.”
Robotic surgery involves tiny instruments controlled remotely by a surgeon at a nearby computer board. It improves maneuverability and precision, allowing a surgeon to go where his hands won’t normally fit.
With a tiny camera attached, it also provides a more magnified view of hard to see places within the thoracic cavity, helping the surgeon achieve a more complete resection of the tumor cells.
Although it is typically associated with minimally invasive surgery, the patient’s chest still must be opened to do the EPP, which includes the removal of a lung, the lining around it and major parts of the diaphragm.
“Adding the robot doesn’t complicate the surgery. It actually makes it easier,” Gharagozloo said. “It allows us to take out the tumor better. I don’t know if you can say it changes the game, but it enhances what we already are doing.”
Robotics Become a Diagnostic Tool
Gharagozloo believes that robotics also help better identify which mesothelioma patients will benefit the most from aggressive EPP surgery, and which won’t.
He uses it as a final diagnostic tool, in minimally invasive fashion, allowing him to inspect the thoracic cavity before it is opened. If he doesn’t like what he sees, meaning the EPP will not benefit the patient, surgery is not done.
Traditional diagnostic imaging has been less than perfect in the past, and surgeons will start an EPP without fully knowing how much the cancer has metastasized.
“If you have mesothelioma, the last thing you want is to die with an incision on your chest that occurred two months before,” he said. “Surgeons need to know who can have surgery, who should have surgery and who should not. Part of the robotic experience is helping select the right patients for surgery.”
The EPP is major surgery that comes with considerable risk when done traditionally. Some mesothelioma specialists have stopped doing it because the risks often outweigh the rewards.
Too often, elderly patients struggle through postsurgery rehabilitation, quality of life is reduced, and survival time is shorter than if surgery would not have been done.
Without the magnification of the robotic camera, cancer cells often are left behind and tumors regrow quickly. Without the robot as a final diagnostic tool, too many patients who have the surgery are hurt, not helped by the operation.
“In Arizona we turned down many, many more patients for surgery than those who actually had it,” he said. “The strength of our program here is that we can tell you, if you likely will benefit. If you’re not, we won’t do the surgery just to say we did something.”
Robotics Make Recovery Easier
Another tangible benefit of the robotic surgery is a dramatic reduction in blood loss, which makes a significant difference in patient recovery. The robotic hands seal the open blood vessels immediately, which traditional surgery doesn’t do.
The loss of blood and extensive blood transfusions often lead to overstressing of internal organs, including the remaining lung after an EPP. That doesn’t happen with robotics.
“A lot of places talk robotics because it sounds good, but they do it once a month. That’s like trying to be an occasional marathon runner. You’re not going to be very good at it,” he said. “We don’t do robotics for marketing here. This is what we live, and this is what we do all the time. We’ve got surgeons using the robot eight to 10 times a day.”
Teamwork Is the Key
Gharagozloo was so confident in his move to Celebration Health that he brought much of his thoracic surgical team from Arizona, including his surgical first assistant, surgical nurse, nurse practitioner and even his office manager. Their team work is impressive.
“Mesothelioma is more than a one-man show. It takes an experienced village to give patients the finest care they can get,” he said. “That’s what we bring to the table, the experience in dealing with what we can, and can’t do. That’s what makes us special here.”
Gharagozloo wants to share what he has learned from robotics and mesothelioma, changing the gloom-and-doom perception that often comes with a diagnosis.
“I don’t want to be the only guy who can do a pleurectomy (removing the lining around he lung) with a robot. That doesn’t make sense,” he said. “There is a lot of opportunity here to take what we have, show others, and let them learn from it. Then everyone benefits.”