Transcription:

Scott Webb (Host): Minimally invasive, robotic and video assisted surgeries using the da Vinci robotic system and other technologies are becoming more and more common. And that includes thoracic surgeries as well. And joining me today is Dr. Jason Fitzgerald. He's a Thoracic and Cardiothoracic Surgeon With Franciscan health,

This is the Franciscan Health Doc Pod. I'm Scott Webb and Dr. Fitzgerald, we're talking about video and robotic assisted surgeries today. So you seem like the perfect guest. As we get rolling here, what is minimally invasive thoracic surgery? What does that mean exactly?

Jason Fitzgerald MD (Guest): Traditionally most surgery in the chest was done through one of two incisions either what's called a median sternotomy incision, where the sternum is split to access the front part of the chest, or an incision called a thoracotomy, which is a large incision on the side of the chest in which a retractor is placed between the ribs to spread the ribs, to give the surgeon visualization of structures in the chest, like the lung. Minimally invasive thoracic surgery refers to methods of doing the same procedures that use those bigger incisions, but doing them through smaller incisions. The first real minimally invasive type of thoracic surgery has been around now probably for about 30 years. And it's called video assistant thoracoscopic surgery. And that's where, a few small incisions are made and a camera is put through one of them and instruments are put through some of the others. It's really the same concept is a laparoscopic surgery in the abdomen or pelvis, except that it's done in the chest. And then more recently, there has been the development of robotic assisted thoracoscopic surgery. And so instead of just using a camera and instruments through the port, a robot is used that has multiple arms that go through ports and it has its own camera. And the advantages of that, are that the camera has 3D imaging that's very clear. I mean, the visualization is amazing. And then the other thing is that the robot actually gives the operator three arms to work with all at once. And the operator also controls the camera.

The instruments that are inside the patient, actually articulate just like a wrist and hands. So, it really is very intuitive to learn and it gives the operator a really enhanced ability to perform different maneuvers inside the patient. So, I really see the robot as sort of the evolution of thoracoscopic surgery past just a two dimensional camera and, and instruments

Host: Yeah, I see what you're saying. I'm sure it's just a benefit to everybody involved, but specifically about the patients, what are the benefits to the patient of the minimally invasive approach and specifically, the robotic assisted surgeries?

Dr. Fitzgerald: The main benefits of the smaller incisions, are less blood loss, less pain typically, and quicker recovery and a quicker return to normal activities. Essentially the same procedure is being done on the inside as, would be done with a large incision. There's not any type of survival advantage. It's all about recovery. And the recovery just happens, you know, faster and that includes time in the hospital. And then, like I said, time to get back to normal activities.

Host: Yeah, so shorter stay in the hospital, faster recovery, smaller scars. Those all are ringing in my ears. Those all seem like good things for patients. And so when we just stay with the robotic assisted and we talk about the da Vinci, I think a lot of people have heard about the da Vinci, but maybe aren't exactly sure what that means. So maybe you can tell us more about the da Vinci robot, the surgery, benefits to patients and so on.

Dr. Fitzgerald: Yeah. It's kind of funny because when you tell people you're going to use a robot for the surgery, they get all kinds of ideas in their head about it. The robot is a, it's a tool. It doesn't do the operation. It's essentially a machine with four arms on it. And it comes with its own instruments and we make these little incisions in the chest and we put these ports in which are like little tunnels, or maybe you might see them as large straws. And then we bring the robot to the patient and we put the instruments in the robot arms and then the instruments go through these ports into the patient.

And one of those is the camera. And then the surgeon, actually scrubs out and takes control of the robot at a control panel, which is in the room just a few feet from the patient, and actually sits at a console where you put your face into this thing, and you're basically looking kind of through three-dimensional goggles at the inside of the patient.

And then you have your fingers go into these like little gloves so that you can move your hands and move your wrists and it's really amazing. It's kind of like you're taking control, you know, of an airplane or something like that. It's pretty cool. Yeah.

Dr. Fitzgerald: But yes, the robot's just a, it's a platform. It's a tool for translating the surgeons movements into the patient and kind of back in the other direction, transmitting really exceptional visualization of different anatomic structures.

Host: Yeah. I think you're so right, I think most of us have just seen too many scifi movies, too much Star Trek Star Wars. And we picture, you know, like one of those actual like droids or robots doing surgery, but just to be clear, the doctors are doing the surgery. But it's robotic assisted surgery. And the, as you say, the visualization and the benefits to patient, and let's not deny that robots are just undeniably cool. Like that's just really cool.

Dr. Fitzgerald: It is very cool. Yeah, what's really amazing is translation of fine movements and fine precise movements of the operator's hands to these tiny little sort of mechanical hands that are inside the patient. It's just it's, it's really cool. Yeah.

Host: Yeah. And I've also heard from other docs that the visuals, that the magnification something like 40 times, you know, and I can't even get my mind around how big that must look to you, but how beneficial it must be as the one, you know, performing the surgeries.

Dr. Fitzgerald: Right. Yeah, it really is because we've always sort of thought that the gold standard is, you know, looking at something with directly with your eyeballs. But when you're looking at it with your eyeballs, you're standing at the table and probably looking at a structure from a couple of feet away and with the robot, it brings you into a couple of inches away, and just the level of detail, you can see every tissue plane, and it makes the dissections, easier. And, it's, it's really neat.

Host: Yeah, it really is. And I love these conversations. I just find them so educational and I'm sure listeners do as well. And I, in doing my preparation, I know there's an entire whole list and we probably won't get to all of them. But when we think about when robotic surgery, when robotic thoracic surgery is needed or indicated, maybe you can just go through some of the highlights if you will.

Dr. Fitzgerald: Sure. I really think that robotic surgery is indicated for almost any type of condition that you would use open surgery for in the chest, with the exception of heart surgery. That's sort of a different department, but with regard to surgery on the lungs or the airways or things that may occur in the, you know, in the middle of the chest, outside the heart, things that happen in the esophagus for any of those, I really think that the robot is indicated. It might be more useful to say when the robot isn't indicated and occasionally we have to deal with things like where there's so much scar tissue inside a patient that you can't get any visualization, or the kind of thing where you have to kind of get your hand in and feel something, that you can't necessarily see.

But for most things, the robot is indicated. And I guess, what are some common things that we use for, for thoracic surgery, really common one is removing lung cancer. That's kind of been a game changer for patients who have lung cancer, because the typical stay in the hospital used to be four or five days, and now it's around two or three days, using the robot. So, it's a lot faster, but I think that's the most common thing that we use the robot for is, is removing lung cancers or taking biopsies of the lungs and that sort of thing.

Host: Yeah. And as we wrap up here, doctor, and as I mentioned, this is really educational. And even though you and I were sort of geeking out over robots, maybe not everybody has that same feeling about robots. So, for folks who are listening to this who may be facing, unfortunately, some of these surgeries or diagnoses, and maybe have some apprehension about robotic assisted surgery. Maybe you can just kind of give them some takeaways and reassure them that it's the doctors doing the surgery, the robots help the doctors, helps, you know, recovery time. And so on that there are just so many benefits that we want them to want to have the robots involved.

Dr. Fitzgerald: If the operation can be done with a robot, there's a lot of benefits that we discussed. I mean, principally, the minimally invasive faster recovery. And I would just reiterate that the robot is, just a tool. It's just an extension of, the doctor is controlling it, this isn't artificial intelligence or anything like that. It's just the surgeon is there in the room at the bedside. You know, if anything happens or, you know, we need open that can be done immediately. So, it's very safe. The results are really amazing. I think patients who've had it are really, really happy. We can't do everything with the robot, but, I think that, it really has become a game changer for thoracic surgery.

Host: Yeah, it really has. And it has seemingly become the gold standard. And maybe there'll be a someday when it's doctor assisted surgeries, robots doing the surgery and the doctor's just there assisting them. But that's often the future in science fiction. For today, it's doctors with robotic assisted surgery, and I really appreciate your time. Thanks so much. You stay well.

Dr. Fitzgerald: Okay. Thank you very much.

Host: Franciscan Health has the best surgical team and the latest technologies. At Franciscan Health, you can be confident about your choice of minimally invasive surgery and for more information, go to Franciscanhealth.org and search robotic surgery.  And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.