Robotic Surgery for Mesothelioma

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A robotic surgery system can enhance the abilities of a surgical team, allowing them to perform an aggressive surgery more safely. At this time, only specialized cancer centers have the equipment and expertise necessary to perform robotic surgery for mesothelioma.

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Top Mesothelioma Specialists for Robotic Surgery

Since surgeons began exploring the use of robotic systems for chest cancer procedures, several accomplished mesothelioma specialists have begun to advocate for the technology.

Farid Gharagozloo, Thoracic Surgeon & Expert Contributor for Asbestos.com

Dr. Farid Gharagozloo

Dr. Farid Gharagozloo is the medical director of general, cardiovascular and thoracic surgery at AdventHealth Celebration near Orlando, Florida. He did his residency in general and thoracic surgery, and he specializes in robotic techniques and surgical procedures for pleural mesothelioma.

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Dr. W. Charles Conway, peritoneal mesothelioma doctor & expert contributor for Asbestos.com

Dr. W. Charles Conway

Ridley-Tree Cancer Center

Dr. W. Charles Conway is an expert in peritoneal mesothelioma and the Director of Surgical Oncology at Ridley-Tree Cancer Center in Santa Barbara, California. He specializes in minimally invasive robotic surgery and heated chemotherapy for peritoneal mesothelioma.

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Dr. Mark Dylewski, Director of General Thoracic Surgery and Thoracic Surgical Oncology

Dr. Mark Dylewski

Dr. Mark Dylewski is the director of general and thoracic surgery at Baptist Health in Miami. He is board-certified in general and thoracic surgery, and he is well known for the "Dylewski Technique," which uses robotic surgery to perform safer lung lobectomies.

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Dr. R. Taylor Ripley, Director of the Mesothelioma Treatment Center at Baylor College of Medicine

R. Taylor Ripley, M.D.

Director, Mesothelioma Treatment Center at Baylor College of Medicine at Lung Institute at Baylor College of Medicine

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Jason P. Shaw, M.D.

Director of General Thoracic Surgery at Maimonides Medical Center

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Dr. Kiran Turaga, Surgical Oncologist

Kiran Turaga, M.D.

Surgical Treatment of Abdominal and Peritoneal Diseases at University of Chicago Comprehensive Cancer Center

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Dr. Aaron Mansfield - Medical Oncologist

Aaron S. Mansfield, M.D.

Lung Cancer and Mesothelioma Immunotherapy at Mayo Clinic Minnesota

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Dr. Robert Ramirez, Medical Oncologist

Robert Ramirez, M.D.

Lung Cancer, Pleural Mesothelioma, Research at Ochsner Medical Center

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Dr. Jack A. Elias, Chairman of the Department of Internal Medicine at Yale University

Jack A. Elias, M.D.

Internal Medicine: Pulmonary & Critical Care Medicine at Yale New Haven Health Smilow Cancer Hospital

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Dr. W. Charles Conway, peritoneal mesothelioma doctor & expert contributor for Asbestos.com

W. Charles Conway, M.D.

Peritoneal surface malignancies, complex oncologic surgeries at Ridley-Tree Cancer Center

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Dr. Betty Tong, Cardiothoracic Surgeon

Betty Tong, M.D.

Cardiovascular and Thoracic Surgery at Duke Cancer Center

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Dr. Nathan Pennell, Medical Oncologist

Nathan Pennell, M.D.

Mesothelioma, Lung Cancer, Clinical Trials at Cleveland Clinic Cancer Institute

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Dr. Neil Christie, Assistant Professor of Surgery

Neil Christie, M.D.

Minimally Invasive Thoracic Surgery at UPMC Hillman Cancer Center

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What Procedures Benefit from Robotic Surgery?

For some pleural mesothelioma patients, an aggressive tumor-removing surgery such as an extrapleural pneumonectomy (EPP) offers the best chance of extending survival. During an EPP, surgeons remove the diseased lung, as well as parts of the tough, fibrous protective lining surrounding the heart and chest, nearby lymph nodes and part of the diaphragm if necessary.

However, EPP procedures carry great risks. The invasive procedure involves a difficult recovery period, and surgeons often discover patients are poor candidates for surgery only after making a major incision to open the chest.

Robotic Surgery Facts

  • Gives surgeon a 3D-magnified view inside the patient’s body
  • Allows for very precise movements using miniature robotic hands
  • Enables better preoperative evaluation of cancer spread
  • Reduces blood loss during aggressive tumor-removing surgery

In robotic surgery, a surgeon uses remote-control surgical tools and sees inside the patient’s body through a 3D camera. The tools and camera are mounted on little robotic arms that can fit through small incisions in the patient’s chest.

This allows the surgeon to evaluate the extent of tumor growth and minimize bleeding before making a major incision to complete the surgery. This way, patients who cannot benefit from surgery are spared an extensive procedure, and patients who can benefit have an easier recovery.

How Does Robotic Surgery Work?

Innovative robots such as the da Vinci Surgery System are designed to minimize the harmful side effects of surgery. Robotic surgery is an evolved form of video-assisted thoracoscopic surgery (VATS).

In the VATS technique, a surgeon uses long, thin tools and a camera on a probe so they can see what they are doing without completely opening the chest. Many specialists rely on VATS to perform biopsy procedures as part of a mesothelioma diagnosis.

VATS is not ideal for more complex procedures, however, because the 2D camera eliminates the surgeon’s depth perception, and the tools are counterintuitive to use.

A robotic surgery system solves these problems by giving the surgeon a magnified 3D view and translating the surgeon’s movements into precise movements of tiny robotic hands. The surgeon can adjust the sensitivity of the controls as needed, and the system automatically filters out any tremor in the surgeon’s fingers.

The robotic systems used by mesothelioma specialists do not involve any kind of artificial intelligence — they are merely superior tools for human surgeons to use. The surgeon’s view is also projected onto screens in the operating room so the entire surgical team can collaborate during surgery.

Surgeons have used robotic tools for chest cancer procedures since 2006. In 2013, the first robotically assisted EPP was conducted using the da Vinci Surgical System.

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Advantages for Mesothelioma

Robotic systems can significantly improve surgery for pleural mesothelioma.

Better Patient Selection

Sometimes imaging scans do not reveal the full extent of cancer spread, which can lead to a patient undergoing an aggressive procedure that does more harm than good. Remote-control robotic tools allow a surgeon to thoroughly look around inside the patient’s body before making the final decision to go ahead with the more invasive portion of the procedure.

Improved Cancer Cell Removal

With a high-definition 3D camera and tiny, computer-stabilized robotic tools, a surgeon can locate and remove cancer growth much more accurately than using only the human eye and fingers.

Reduced Blood Loss

Blood loss is a major concern in conventional EPP procedures, because it can lead to surgical complications and a more difficult recovery. With robotic tools, however, a surgeon can stop bleeding quicker and more efficiently, vastly reducing the amount of blood loss. Patients undergoing robotic surgery typically only need to spend days recovering in a hospital bed, compared to weeks with traditional surgery.

Disadvantages of Robotic Surgery

Robotic surgery systems require extensive training to operate effectively. Some experienced surgeons have no interest in learning to use these new tools, and other surgeons are skeptical that robotic systems provide significantly greater benefits than VATS techniques.

The high cost of the technology is a barrier for many hospitals and cancer centers. However, proponents believe if patients spend fewer days recovering in a hospital bed, a surgical practice can realize great savings in the long run.

In any case, until the technology becomes more widespread, patients will have to travel to one of a handful of advanced cancer centers around the country to find a surgeon with experience treating mesothelioma through robotic surgery.

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Registered Nurse and Patient Advocate

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at Asbestos.com
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11 Cited Article Sources

  1. Cerfolio, R. et al. (2017, September). Consensus statement on definitions and nomenclature for robotic thoracic surgery.
    Retrieved from: http://www.sciencedirect.com/science/article/pii/S0022522317310851
  2. Shen, J. (2017, June). Prof. Abbas E. Abbas: a robotic thoracic practice can provide both clinical and financial benefits for an academic institution.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506173/
  3. Louie, B. et al. (2016, September). Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database.
    Retrieved from: http://www.sciencedirect.com/science/article/pii/S0003497516301345
  4. Nguyen, D. et al. (2015, December). Robot Assistant Extrapleural Pneumonectomy for Mesothelioma.
    Retrieved from: http://www.ingentaconnect.com/content/asp/ajrs/2015/00000002/00000001/art00007
  5. Ye, X. et al. (2015, October). Robotic thoracic surgery versus video-assisted thoracic surgery for lung cancer: a meta-analysis.
    Retrieved from: https://academic.oup.com/icvts/article/21/4/409/838977
  6. Kumar, A. and Bin Asaf, B. (2015, January). Robotic thoracic surgery: The state of the art.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290121/
  7. Lee, B. et al. (2014, February). Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages?
    Retrieved from: http://www.sciencedirect.com/science/article/pii/S0022522313011641
  8. University of Arizona. (2013, April 12). World’s First Robot-Assisted Surgeries for Mesothelioma.
    Retrieved from: https://www.technology.org/2013/04/12/worlds-first-robot-assisted-surgeries-for-mesothelioma/
  9. Florida Hospital Global Robotics Institute. (n.d.). Robotic Thoracic Surgery.
    Retrieved from: https://www.globalroboticsinstitute.com/en/robotic-treatments/thoracic-surgery
  10. H. Lee Moffitt Cancer Center. (n.d.). Robotic Surgery in Tampa, FL.
    Retrieved from: https://www.floridachestsurgery.com/robotic-surgery/
  11. Loyola University Medical Center. (n.d.). Robotic Surgery. Retrieved from: https://www.loyolamedicine.org/surgical-services/robotic-surgery
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Last Modified November 1, 2019

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