New Hope On the Horizon!
The University of Montreal Hospital Research Center, also known as CRCHUM has publicly released some intensely exciting news this month. They have initiated a new surgical approach and it will be tested for patients with lung cancer.
The surgical approach possesses four qualities which make it an exciting and encouraging technique in lung cancer treatment. It is named with the tongue twisting phrase, “video-assisted thoracoscopic (VATS) lobectomy with ultrasonic pulmonary artery sealing.” The four special qualities are:
1. Less Invasive,
2. Less Bleeding
3. Video Camera Assisted
4. Faster Recovery
Making Medical History
On January 19, 2016, Dr. Moishe Liberman removed a one-centimeter long tumor from the left lung of a lung cancer patient Monic Ste-Marie, age 48.
She has become one of the first human beings to enjoy the amazing benefit of this new procedure.
Dr. Liberman, who is a thoracic surgeon and researcher at the CRCHUM, accomplished the surgery by creating only three small incisions in her chest. From that point he was guided by a video camera as he removed the diseased part of the lung.
New Surgery Means Hope for Lung Cancer Patients.
The camera continued to delicately guide him as he utilized an electronic device to seal the pulmonary artery with ultrasound to prevent bleeding during the operation.
Dr. Liberman, is also an Associate Professor of Surgery at the University of Montreal, and he reported, “I think this technique could completely change the way we perform surgery for lung cancer, which is the deadliest form of cancer in North America.” What Do We Do Now?
One of the most often performed lung cancer surgeries, all over the world, is the almost offensively invasive pulmonary lobectomy.
The chest is cut open and the ribs are spread. The entire lobe of the lung containing a large cancerous tumor is removed. There follows a tortured and painful six months recovery for the patient. The scar is long and ugly, a grim reminder of the miserable operation.
What Changed To Make It Possible
The last 20 years saw the rise of a new technique and revolutionary equipment. We are speaking of the video-assisted thoracoscopic (VATS) lobectomy. “Instead of making a long incision in the chest and breaking the ribs, surgeons simply make small holes to reach the target area.” The miniature video camera is inserted through one of those holes, and into the chest wall. It will be the surgeon’s eyes.
So, What Is The Downside?
Dr. Liberman explained, “The technique is beneficial, but it is not widely practiced, because the risk of major bleeding makes it difficult to control.”
Pulmonary arteries are insanely delicate, very thin and fragile. And the camera can only see so much of the area around it. What if bleeding happens and the surgeon does not see it? (Hint: It’s Not Good!)
When bleeding happens in the open chest, it is quite obvious. It can be immediately stitched up.
However, if bleeding is occurring and we cannot see it on camera, the patient dies very quickly. If you remember basic anatomy, you know why: “The pulmonary artery is connected directly to the heart,” stated Dr. Liberman.
How To Seal An Artery: The Modern Way!
Simultaneously with the development of the video, another research group at another association, Ethicon, was developing the HARMONIC ACE +7. This odd-looking instrument has a pistol grip at one end and a tiny 3 millimeter jaw at the other end. Ethicon, who is part of Johnson and Johnson, created it to seal up small blood vessels under 7 mm in size.
It uses ultrasonic energy to do this. As Dr. Liberman continues to use this ultrasound gun, it is hoped it will continue to work effectively for the delicate pulmonary artery branches.
The Trials!
New Surgery for Old Lungs
For 5 years, Dr. Liberman and his colleagues did pre-clinical studies with animals, then clinical phase 1 and 2 trials. Now Dr. Liberman is leading large Phase 2 clinical trials which will discover the success results in 150 patients in Canada, the US, and Europe.
Johnson and Johnson has provided the funding, $1.8 million dollars, but we won’t know results until four years from now.
FLASS hopes the procedure will be richly rewarding for both patients and surgeons.
“Each year, lung cancer kills around 1.59 million people in the world, largely due to smoking, which is responsible for 80% of cases according to the World Health Organization.”
Lung cancer brings alarm, anger and tremendous sadness to the patient and the family. Quite often the disease is diagnosed late and there is very little hope. Likewise, the survival rate beyond five years after diagnosis is very low: 17 percent of the diagnosed women get to survive beyond 5 years, and 14% of the men who contract it have more than 5 years.
Dr. Liberman stated, “I think it will decrease the risk of bleeding and reduce post-operative pain. Patients will be able to resume their normal lives more quickly,” he said.
What happened to his pioneering patient, Monic Ste-Marie? She was a lucky one. Because she was lucky, her lung cancer was diagnosed quickly. It has now been six months since the new medical procedure saved her. She said, “I had pain for a month after the operation. Now, I still have trouble catching my breath, but that’s normal,” she said, matter-of-factly.
Some surgeons in addition to Dr. Lieberman are already sold on the technique.
“Thoracoscopic lobectomy should be considered the standard of care for patients with early-stage lung cancers,” says Michael Reed, MD. Dr. Reed is also assistant professor of surgery at University of Cincinnati, and minimally invasive thoracic surgeon at University Hospital. “But few surgeons offer the procedure because it’s difficult and requires a lot of additional training.” What is remarkable is that Dr. Reed said this in 2007, when the supportive technology was not yet invented.
The difficulty and the learning curve are the dark secrets behind this futuristic new style of surgery, but the Florida Lung, Asthma and Sleep Specialists will be following the developing technologies with great interest and high hopes.