For patients with advanced lung disease, time is of the essence. The fastest, most accurate path from diagnosis to treatment is robotic technology.
Robotics at Cedars-Sinai
Home to one of the busiest robotic thoracic surgery programs in the western U.S., Cedars-Sinai is a leader in the use of robotic technologies to diagnose and treat patients. The expert, multidisciplinary team of surgeons makes it a priority to master new platforms that allow for minimally invasive treatment of complex disease, higher accuracy in cancer staging and improved patient outcomes.
Harmik J. Soukiasian, MD
Anatomic lung resections, including segmentectomies, are among the comprehensive list of lung surgeries that the Cedars-Sinai thoracic surgery team now performs using robotics. Dr. Harmik J. Soukiasian, vice chairman of Surgery, Clinical Outreach, who leads the team in robotic lung surgery, favors robotic technology for many reasons, including its ability to supercharge the precision of procedures by injecting a marker into healthy lung tissue.
"We inject indocyanine green, a dye marker that is carried by blood vessels to the areas of lung we are trying to spare, indicating where to resect," says Dr. Soukiasian, who’s also director of the Division of Thoracic Surgery and the Tawil Family Endowed Chair for Thoracic Surgery. "We've maximized the amount of pathologic lung we're removing, and we've maximized the amount of normal lung we're leaving in, which is not possible with video-assisted thoracoscopic surgery (VATS) or open surgery."
"With robotic technology, a surgeon can perform both the marking of nodules or cancer and the resection with a high degree of accuracy."
This increase in accuracy enhances the surgeon's ability to perform anatomic sublobar resections, which is important for patients with decreased lung function, for whom preserving healthy lung tissue is critical to quality of life.
In addition to increased accuracy, the minimally invasive nature of robotic surgery often allows patients to get back home sooner than was previously possible. For example, data collected at Cedars-Sinai indicates that robotic lobectomy patients are discharged a full day earlier than VATS lobectomy patients, with a similar overall hospital cost between the two surgical approaches and excellent patient outcomes.
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Robotic navigational bronchoscopy platform technology
As one of only a few programs in the country that has all three robotic thoracic surgery platforms available, Cedars-Sinai is an ideal program to launch new technologies. In late September, the medical center added a new robotic navigational bronchoscopy platform to its comprehensive list of innovative robotic technologies.
This new platform is the only robotic-assisted bronchoscopic platform that allows for successful biopsy of peripheral lung nodules and offers several important advantages to surgeons over prior electromagnetic navigational platforms. The robotic-assisted bronchoscopic platform allows for navigation under direct visualization with a 2 millimeter fiber optic camera, which increases precision and accuracy. Anatomical markers illustrate pleural borders and blood vessels—thus allowing for safer biopsy—and the platform utilizes custom-designed, flexible needles which can pass through tight bends to perform biopsies in difficult locations, such as the apex of the lung. Cedars-Sinai already is one of the busiest programs in the country that offers this technology.
Taryne A. Imai, MD
With greater reach, more stability, a higher diagnostic yield and an exceptional level of accuracy as compared to prior technologies, this newest robotic navigational technology is a particularly effective option in instances when the nodules are smaller, farther into the lung periphery and more difficult to reach. Led by Dr. Taryne A. Imai, the team uses the technology to provide streamlined comprehensive care, from diagnosis to surgical treatment for their thoracic surgery patients.
"It is much better in many aspects than prior technology," says Dr. Imai. "The new platform gives us the ability to reach more peripheral and smaller nodules with more stability, accuracy and improved safety."
To date, the navigational bronchoscopy platform has enabled the team of surgeons at Cedars-Sinai to provide a diagnosis in over 95% of cases—as compared to the average 50% to 80% diagnostic yield using other technologies.
Cedars-Sinai is the only institution in Los Angeles with this particular robotic capability, and one of only 30 or so nationwide. A second machine will be added in early 2021, making Cedars-Sinai the only institution in the country with two. This will enable the thoracic surgery and interventional pulmonology teams to schedule additional procedures and serve a greater number of patients.
"That continuity of care is a huge focus. Our workflow from diagnosis to treatment is a lot more efficient, and in cancer that's important."
Better technology, better outcomes
The benefits of robotic technology to both physicians and patients are myriad.
Patients see shorter hospital stays, better surgical outcomes and decreased pain. The time to service is shortened considerably, taking the lung cancer patient from tissue diagnosis to scheduling surgery within weeks.
The thoracic surgery team at Cedars-Sinai can now offer patients the full complement of services—from diagnostic procedures to surgery—providing lifesaving, expedited care.
"That continuity of care is a huge focus," says Dr. Imai. "Our workflow from diagnosis to treatment is a lot more efficient, and in cancer that's important."
Robotic technology—and this newest platform in particular—can get nodules near the fissure or diaphragm that radiologists are not able to effectively biopsy. And because biopsies using robotics technologies are performed from the inside, or endoscopically, the pneumothorax rate is significantly lower than a classic CT-guided biopsy performed from the outside or percutaneously.
The 3D, magnified visualization of the robotic surgery platform allows the surgeon to harvest significantly more lymph nodes than VATS—when treating lung cancer, that means more accurate pathologic staging and cancer therapies that are tailored to the patient.
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The future is here
At Cedars-Sinai, robotics is not just the surgical technology of the future, but of the present.
"Every operation that we did open or VATS, we now do robotic—including pneumonectomies," says Dr. Soukiasian. "We always consider the minimally invasive option. And we have the lowest conversion-to-open rate in the city."
With robotics technology rapidly advancing as instrument size decreases and accuracy increases, Cedars-Sinai is poised to continue to be a leading medical center for robotic surgical innovation.