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Robotic Assisted Lung Surgery
Dr. Amanda Eilers discusses Robotic Lung Surgery.
Featured Speaker:
Amanda Eilers, DO
Amanda Eilers, DO is a Cardiothoracic Surgeon whose Special Clinical Interest include Minimally invasive/robotic thoracic surgery, coronary artery bypass surgery, and TAVR. Transcription:
Robotic Assisted Lung Surgery
Prakash Chandran: Robotic surgery has advanced quite a bit in the past few decades and machines like the da Vinci XI claimed to be the most advanced minimally invasive option for complex surgeries. Surgeons at the Aspirus Wausau Hospital have been using the da Vinci robot surgical system since 2007 to offer patients the best possible outcomes.
We're going to talk about it today with Dr. Amanda Eilers, a cardiothoracic surgeon at Aspirus Health. This is Aspirus Health Talk, the podcast from Aspirus Health. I'm Prakash Chandran. So first of all, Dr. Eilers, it is great to have you here today. What exactly is robotic-assisted surgery?
Amanda Eilers: Robotic surgery utilizes technology in that we can use small incisions and, through those small incisions, the robotic arms get attached. And then the instruments go through the robotic ports. And then I sit next to the patient at a console, being able to see in very high definition through the robotic camera and do surgery using the robotic instruments.
So I have complete control over the instruments and the robot helps me do the job, but I'm still doing the surgery. So this allows for very precise movement of my hands via the robotic instruments under high definition three-dimensional view.
Prakash Chandran: So it's really just an extension of your arms, wouldn't you say?
Amanda Eilers: That's correct. Yep.
Prakash Chandran: Okay. And since we're talking about lung surgery today and as it relates to robotic-assisted surgery, you talk a little bit about that procedure specifically?
Amanda Eilers: Sure. So lung surgery has gone through many changes over the last couple of decades. Initially, surgery was performed via a thoracotomy, which is a very large incision and the ribs are spread. That can be quite painful and can lead to a longer hospital stay, more blood loss and a slower return to work. Over the last two decades, as lung surgeons, we've been working toward more minimally invasive options, and those options include video-assisted thoracoscopic surgery or VATS surgery. And now more commonly, the robotic approach. And as I mentioned, the robotic incisions are quite small, even smaller than the VATS incisions. And we can perform a number of thoracic surgeries, including lung resections, most commonly for lung cancer. The patients that we're able to do robotic surgery on have shorter length of stay, decreased bleeding, and a quicker return to work.
Prakash Chandran: Yeah, that sounds amazing. And I imagine there's probably fewer complications as well, right?
Amanda Eilers: Yes. Yep. Usually with small incisions, even though it's "minimally invasive," we're still doing a big surgery on the inside. Sometimes the surgery can take a little bit longer because we're working through small incisions, but usually the outcome is much more patient, because of the smaller incisions and less pain and a quicker return to normal activities.
Prakash Chandran: Okay. So through that small incision and just so I can try to get a good grasp on what's happening, robotic arms have a little camera inside, so you can exactly see what's happening. Is that correct?
Amanda Eilers: Yes. So there's four arms on the robotic XI system. One of those arms has a camera that I have complete control over. And then the three other arms have various instruments that I use throughout the operation. So I have complete control over the camera where I'm able to see within the chest and then each of the arms to do the anatomic dissection and resection of the lung.
Prakash Chandran: I see. And you mentioned a video-assisted thoracic surgery before. how is that different than robotic-assisted surgery?
Amanda Eilers: Sure. So very similar concepts in the sense that you're still working through small incisions. However, the camera is more two-dimensional. So the camera optics are not as good as the robotic one. Clearly, there are surgeons across the country that have very good outcomes and good results with VATS surgery. The instruments that you use for the VATS surgery are also an extension of your hands, but they are not wristed, meaning you can't rotate the actual instrumentation, so you can do more fine-tuned dissection with the robotic instruments compared to the VATS instruments.
And some have also noted that when we work on cancer patients and operate to obtain something called a pathologic diagnosis of cancer, we need to do good staging. And that includes doing a lymph node dissection. When you're able to take out more lymph nodes, you have a more thorough lymph node dissection, which usually gives better information for complete staging in our cancer patients.
Prakash Chandran: So, you mentioned a lot of different benefits, having robotic-assisted surgery. it seems like everyone would want to do this, I'm curious as to who might be a good candidate for it? Is it for everyone or do you have to fit a certain criteria?
Amanda Eilers: Sure. That's a really good question that I often get asked by my patients. So one of the biggest things that are going to determine if you're a candidate for robotic surgery is what is the pathology or the underlying problem that you have. If that is say a lung cancer, if that lung cancer is small and earlier stage, then you're usually going to be a candidate for the robotic approach. If you have a very large tumor, sometimes we end up having to do it the open or the more traditional way. Other disease processes or problems that we can utilize the robot for include lung biopsies, if there's a concern for an interstitial lung disease problem going on, myasthenia gravis or doing thymectomy for patients who have myasthenia gravis or mediastinal tumors and various cysts.
Prakash Chandran: So talk about, surgery in the sense of how doctors view it. Does it tend to be more successful than other methods of surgery, like the VATS or traditional lung surgery?
Amanda Eilers: So the robotic platform is really another tool in our toolbox as surgeons. Obviously, we want to do what is the most safe and beneficial for the patient, whether that falls in the spectrum of the open thoracotomy approach or the robotic approach. You want to make sure that your surgeon is comfortable doing and treating the problem that you have with whichever platform that they feel most comfortable in.
So if someone has never done robotic surgery and they're not comfortable with it, then, your treatment plan may be best with the thoracotomy approach. With that being said, surgeons who are comfortable doing the robotic approach and as long as the patient's anatomy and disease process is conducive to using that approach, the success in staying with the small incisions and completing it robotically is usually very good.
Ultimately things can be found intraoperatively that may direct a different treatment during the operation, which could sometimes mean converting to an open operation, if that was the safest or if that was truly needed based off of the disease process that you're trying to treat
Prakash Chandran: I see. So thank you for that clarification. It sounds like, as you mentioned, it's a tool in the toolbox. If the doctor is experienced in using it, they may opt to use it if the conditions are right. but things could change during the surgery. If they spot something, they might go with a different method. So it really just depends. Did I kind of summarize that well?
Amanda Eilers: Yeah.
Prakash Chandran: Okay. so we talked a little bit about recovery time. If you do get a robotic-assisted surgery, how quickly can someone expect to go back to work afterwards?
Amanda Eilers: Sure. So just to kind of give you rough timeline, in open approach, you're usually in the hospital, about five days or so, give or take. With the robotic approach, again, depending on what disease process was treated, but if we compare a lung resection for lung cancer, so getting one of the lobes of your lung removed, if you did it in an open way, it would be roughly about five days in the hospital. If you did it the robotic way, you're usually out of the hospital within two days. So you cut down about three days in the hospital, and then the amount of pain that you have compared to the open is much less.
So those are going to be the factors that get you up and moving, back to work quicker. Now, compared to belly surgery, the chest is a rigid cavity. So you don't have to worry necessarily as much regarding incisional hernias or "popping stitches." You still need to be mindful, but after the robotic surgery, the incisions are small. And usually the activities of daily living and going back to work, some patients can go back to work within a week or two compared to several weeks after an open thoracotomy.
Prakash Chandran: So, you know, if someone is listening to this and, have a potential lung surgery coming up, is this something that they need to talk to their doctor about, or will the doctor be the one to evaluate whether robotic-assisted surgery is right for them?
Amanda Eilers: I think it really depends on which doctor they see first. As a patient, you want to make sure that all of the options are explained to you. And if you aren't hearing the variety or the range of options that are available, then you should inquire about that with your doctor, whether that's seeking another opinion or talking to a surgeon to hear all of the options.
Prakash Chandran: So just as we close here, is there anything else that you would like to share with our audience about robotic-assisted surgery or lung surgery?
Amanda Eilers: I think it's an exciting time in our field and the amount of advancements that we've been able to do using these small incisions and the technology of the robot, really outstanding. And I look forward to continuing to grow the robotic program here that we have at Wausau Aspirus Hospital and providing this opportunity and technology for our patients here in rural central Wisconsin.
Prakash Chandran: Well, Dr. Eilers, I truly appreciate your time today. Very informative.
That's Dr. Amanda Eislers, a cardiothoracic surgeon at Aspirus Health. For more information, call (715) 847-0400 or head to a Aspirus.org/heart-lung-surgery. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This has been Aspirus Health Talk. Thanks and we'll talk next time.
Robotic Assisted Lung Surgery
Prakash Chandran: Robotic surgery has advanced quite a bit in the past few decades and machines like the da Vinci XI claimed to be the most advanced minimally invasive option for complex surgeries. Surgeons at the Aspirus Wausau Hospital have been using the da Vinci robot surgical system since 2007 to offer patients the best possible outcomes.
We're going to talk about it today with Dr. Amanda Eilers, a cardiothoracic surgeon at Aspirus Health. This is Aspirus Health Talk, the podcast from Aspirus Health. I'm Prakash Chandran. So first of all, Dr. Eilers, it is great to have you here today. What exactly is robotic-assisted surgery?
Amanda Eilers: Robotic surgery utilizes technology in that we can use small incisions and, through those small incisions, the robotic arms get attached. And then the instruments go through the robotic ports. And then I sit next to the patient at a console, being able to see in very high definition through the robotic camera and do surgery using the robotic instruments.
So I have complete control over the instruments and the robot helps me do the job, but I'm still doing the surgery. So this allows for very precise movement of my hands via the robotic instruments under high definition three-dimensional view.
Prakash Chandran: So it's really just an extension of your arms, wouldn't you say?
Amanda Eilers: That's correct. Yep.
Prakash Chandran: Okay. And since we're talking about lung surgery today and as it relates to robotic-assisted surgery, you talk a little bit about that procedure specifically?
Amanda Eilers: Sure. So lung surgery has gone through many changes over the last couple of decades. Initially, surgery was performed via a thoracotomy, which is a very large incision and the ribs are spread. That can be quite painful and can lead to a longer hospital stay, more blood loss and a slower return to work. Over the last two decades, as lung surgeons, we've been working toward more minimally invasive options, and those options include video-assisted thoracoscopic surgery or VATS surgery. And now more commonly, the robotic approach. And as I mentioned, the robotic incisions are quite small, even smaller than the VATS incisions. And we can perform a number of thoracic surgeries, including lung resections, most commonly for lung cancer. The patients that we're able to do robotic surgery on have shorter length of stay, decreased bleeding, and a quicker return to work.
Prakash Chandran: Yeah, that sounds amazing. And I imagine there's probably fewer complications as well, right?
Amanda Eilers: Yes. Yep. Usually with small incisions, even though it's "minimally invasive," we're still doing a big surgery on the inside. Sometimes the surgery can take a little bit longer because we're working through small incisions, but usually the outcome is much more patient, because of the smaller incisions and less pain and a quicker return to normal activities.
Prakash Chandran: Okay. So through that small incision and just so I can try to get a good grasp on what's happening, robotic arms have a little camera inside, so you can exactly see what's happening. Is that correct?
Amanda Eilers: Yes. So there's four arms on the robotic XI system. One of those arms has a camera that I have complete control over. And then the three other arms have various instruments that I use throughout the operation. So I have complete control over the camera where I'm able to see within the chest and then each of the arms to do the anatomic dissection and resection of the lung.
Prakash Chandran: I see. And you mentioned a video-assisted thoracic surgery before. how is that different than robotic-assisted surgery?
Amanda Eilers: Sure. So very similar concepts in the sense that you're still working through small incisions. However, the camera is more two-dimensional. So the camera optics are not as good as the robotic one. Clearly, there are surgeons across the country that have very good outcomes and good results with VATS surgery. The instruments that you use for the VATS surgery are also an extension of your hands, but they are not wristed, meaning you can't rotate the actual instrumentation, so you can do more fine-tuned dissection with the robotic instruments compared to the VATS instruments.
And some have also noted that when we work on cancer patients and operate to obtain something called a pathologic diagnosis of cancer, we need to do good staging. And that includes doing a lymph node dissection. When you're able to take out more lymph nodes, you have a more thorough lymph node dissection, which usually gives better information for complete staging in our cancer patients.
Prakash Chandran: So, you mentioned a lot of different benefits, having robotic-assisted surgery. it seems like everyone would want to do this, I'm curious as to who might be a good candidate for it? Is it for everyone or do you have to fit a certain criteria?
Amanda Eilers: Sure. That's a really good question that I often get asked by my patients. So one of the biggest things that are going to determine if you're a candidate for robotic surgery is what is the pathology or the underlying problem that you have. If that is say a lung cancer, if that lung cancer is small and earlier stage, then you're usually going to be a candidate for the robotic approach. If you have a very large tumor, sometimes we end up having to do it the open or the more traditional way. Other disease processes or problems that we can utilize the robot for include lung biopsies, if there's a concern for an interstitial lung disease problem going on, myasthenia gravis or doing thymectomy for patients who have myasthenia gravis or mediastinal tumors and various cysts.
Prakash Chandran: So talk about, surgery in the sense of how doctors view it. Does it tend to be more successful than other methods of surgery, like the VATS or traditional lung surgery?
Amanda Eilers: So the robotic platform is really another tool in our toolbox as surgeons. Obviously, we want to do what is the most safe and beneficial for the patient, whether that falls in the spectrum of the open thoracotomy approach or the robotic approach. You want to make sure that your surgeon is comfortable doing and treating the problem that you have with whichever platform that they feel most comfortable in.
So if someone has never done robotic surgery and they're not comfortable with it, then, your treatment plan may be best with the thoracotomy approach. With that being said, surgeons who are comfortable doing the robotic approach and as long as the patient's anatomy and disease process is conducive to using that approach, the success in staying with the small incisions and completing it robotically is usually very good.
Ultimately things can be found intraoperatively that may direct a different treatment during the operation, which could sometimes mean converting to an open operation, if that was the safest or if that was truly needed based off of the disease process that you're trying to treat
Prakash Chandran: I see. So thank you for that clarification. It sounds like, as you mentioned, it's a tool in the toolbox. If the doctor is experienced in using it, they may opt to use it if the conditions are right. but things could change during the surgery. If they spot something, they might go with a different method. So it really just depends. Did I kind of summarize that well?
Amanda Eilers: Yeah.
Prakash Chandran: Okay. so we talked a little bit about recovery time. If you do get a robotic-assisted surgery, how quickly can someone expect to go back to work afterwards?
Amanda Eilers: Sure. So just to kind of give you rough timeline, in open approach, you're usually in the hospital, about five days or so, give or take. With the robotic approach, again, depending on what disease process was treated, but if we compare a lung resection for lung cancer, so getting one of the lobes of your lung removed, if you did it in an open way, it would be roughly about five days in the hospital. If you did it the robotic way, you're usually out of the hospital within two days. So you cut down about three days in the hospital, and then the amount of pain that you have compared to the open is much less.
So those are going to be the factors that get you up and moving, back to work quicker. Now, compared to belly surgery, the chest is a rigid cavity. So you don't have to worry necessarily as much regarding incisional hernias or "popping stitches." You still need to be mindful, but after the robotic surgery, the incisions are small. And usually the activities of daily living and going back to work, some patients can go back to work within a week or two compared to several weeks after an open thoracotomy.
Prakash Chandran: So, you know, if someone is listening to this and, have a potential lung surgery coming up, is this something that they need to talk to their doctor about, or will the doctor be the one to evaluate whether robotic-assisted surgery is right for them?
Amanda Eilers: I think it really depends on which doctor they see first. As a patient, you want to make sure that all of the options are explained to you. And if you aren't hearing the variety or the range of options that are available, then you should inquire about that with your doctor, whether that's seeking another opinion or talking to a surgeon to hear all of the options.
Prakash Chandran: So just as we close here, is there anything else that you would like to share with our audience about robotic-assisted surgery or lung surgery?
Amanda Eilers: I think it's an exciting time in our field and the amount of advancements that we've been able to do using these small incisions and the technology of the robot, really outstanding. And I look forward to continuing to grow the robotic program here that we have at Wausau Aspirus Hospital and providing this opportunity and technology for our patients here in rural central Wisconsin.
Prakash Chandran: Well, Dr. Eilers, I truly appreciate your time today. Very informative.
That's Dr. Amanda Eislers, a cardiothoracic surgeon at Aspirus Health. For more information, call (715) 847-0400 or head to a Aspirus.org/heart-lung-surgery. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This has been Aspirus Health Talk. Thanks and we'll talk next time.