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Robotic surgery will be a useful tool as the population ages

Richard Lazzaro, MD, stands in the operating room next to the da Vinci robot system.

With a high lung cancer incidence among the elderly, the minimally invasive approach will be a go-to solution to extend lives

Years ago, it was unheard of for an elderly person to have resection surgery to remove a cancerous tumor.

Surgical risks, such as mortality, cardiovascular issues and post-operative complications that come with all procedures, left clinicians wary of attempting the procedure on older patients. But technology’s acceleration and the advancement of minimally invasive robotic surgery have reversed this thinking, and the older population who previously had few options are now having the procedure and extending their lives.

Early identification, effective treatment

With more than 240,000 new lung cancer cases each year, robotic surgery’s emergence is an innovation benefitting patients regardless of their age, resulting in less trauma and bleeding, quicker recovery and improved outcomes.

For any cancer, screening is important to detect the disease at an early stage. Screening programs have been on the rise in the US. They follow American Cancer Society recommendations that state an annual lung cancer screening with a low-dose CT scan is suitable for higher risk adults between 55-80 who are in fairly good health.

Recognizing it early typically means you have stage 1 lung cancer. And if you aren’t comfortable having surgery, you can still utilize stereotactic body radiation therapy (SBRT or SABR).

Those who are willing can have robotic- or video-assisted thoracic surgery, both of which have yielded less complications and have been tolerated among the elderly population. For example, at Lenox Hill Hospital, we have a 100-percent success rate getting patients through robotic lung resections for cancer and our major complication rate has been just 4.2 percent, which is among the best in the US.

Surgeries that can be done robotically include:

  • Wedge resection: Removes the cancerous tumor and a portion of normal lung tissue.
  • Segmentectomy: Also called segment resection, takes out the segment that includes the tumor. There are 10 segments in the right lung and eight in the left.
  • Lobectomy: Removes a lobe of the lung. 
  • Bilobectomy: Removes two lobes.
  • Pneumonectomy: Removes the entire lung.
  • Sleeve resection: Removes a lobe and the bronchus (part of the airway).
     

Recovering from robotic lung surgery

Patient-specific evaluations are necessary to objectively asses cardiac and pulmonary risks associated with surgery. You need to understand the risks, benefits and alternatives. If someone is non-operative, radiation is the answer. Many patients, though, are strong enough to get home within three days after surgery and get on with their lives.

Overall, it normally takes six weeks to heal from any operation, including robotic thoracic surgery. Follow-up with your surgeon a week after the procedure and increase it to two weeks then a month to make sure they don’t need additional care.

Most patients don’t go home with strong pain medicine because they are generally sore rather than in pain. Tylenol or ibuprofen suffices. You can resume driving about two or three weeks after surgery. An oncologist will further assess if you need additional treatment — called adjuvant therapy — such as chemotherapy. Robotic surgery is beneficial because smaller incisions heal quicker, allowing people to have adjuvant therapy if needed.

Avoid opioids and narcotics

Much has been written about the devastating opioid crisis, which caused thousands of deaths via overdose. With robotic surgery, postoperative pain rarely requires strong narcotic pain medications. Often Tylenol alternating with a non-steroidal anti-inflammatory medication is sufficient.

It’s rare to be prescribed opioids after the procedure for several reasons, including the potential for higher use, which leads to a worse long-term result. Also, opioids can slow your breathing, so it’s best to avoid after lung surgery.

Richard Lazzaro, MD, is a national leader and pioneer in minimally invasive thoracic surgery, including robotic surgery. As chief, he leads the nationally renowned thoracic surgery department at Lenox Hill Hospital.

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