VATS and Surgical Management of Thoracic Malignancies

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
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00:13 --> 00:15Welcome to Yale Cancer Answers with
00:15 --> 00:17your host doctor Anees Chagpar.
00:17 --> 00:19Yale Cancer Answers features the
00:19 --> 00:22latest information on cancer care by
00:22 --> 00:23welcoming oncologists and specialists
00:23 --> 00:26who are on the forefront of the
00:26 --> 00:28battle to fight cancer. This week,
00:28 --> 00:30it's a conversation about the
00:30 --> 00:31surgical management of thoracic
00:31 --> 00:33malignancies with Doctor Andrew Dhanasopon
00:33 --> 00:35Doctor Dhanasopon is an
00:35 --> 00:36assistant professor of thoracic
00:36 --> 00:39surgery at the Yale School of Medicine,
00:39 --> 00:42where Doctor Chagpar is a
00:42 --> 00:43professor of surgical oncology.
00:44 --> 00:46Andrew, maybe we can start
00:46 --> 00:49off by you telling us a little
00:49 --> 00:53bit more about what it is that you do.
00:53 --> 00:56Thoracic surgeons operate on the chest
00:56 --> 00:58most commonly cancers within the chest,
00:58 --> 01:01but we take care of patients
01:01 --> 01:03with both malignant and benign
01:03 --> 01:05conditions within the chest.
01:05 --> 01:07The majority of our patients
01:07 --> 01:09tend to be lung cancer patients,
01:09 --> 01:13and so that tends to be the
01:13 --> 01:14majority of our practice.
01:14 --> 01:18Lung cancer seems to be
01:18 --> 01:21pretty prevalent. Is that still the case?
01:21 --> 01:26Yes, this is still the
01:26 --> 01:30case due to smoking history.
01:30 --> 01:33And it is the number one cause of
01:33 --> 01:36death by cancer in the United States.
01:36 --> 01:40And it is the second most common
01:40 --> 01:42highest incidence of cancer for both
01:42 --> 01:45men and women.
01:45 --> 01:47And when you think about that,
01:47 --> 01:50often on this show,
01:50 --> 01:53we talk about all kinds of different
01:53 --> 01:56modalities that people use to treat cancer,
01:56 --> 01:59whether it's surgery or whether it's
01:59 --> 02:02chemotherapy or whether it's radiation.
02:02 --> 02:04How many patients actually, or
02:04 --> 02:07what proportion of lung cancer
02:07 --> 02:09patients actually are treated with
02:09 --> 02:12surgery? Is that the majority,
02:12 --> 02:15or is that a pretty low number
02:15 --> 02:19compared to the total number of
02:19 --> 02:22patients who are diagnosed each year?
02:22 --> 02:25The number of patients who are
02:25 --> 02:29eligible for surgery is not the
02:29 --> 02:31majority of patients, however, as
02:31 --> 02:34we detect more and more lung cancer
02:34 --> 02:37through lung cancer screening,
02:37 --> 02:39more patients are identified earlier
02:39 --> 02:42in the disease process and thus are
02:42 --> 02:45eligible for surgery as a treatment.
02:45 --> 02:48As a surgeon, I guess
02:48 --> 02:51I am a little bit biased,
02:51 --> 02:54but I often think that when
02:54 --> 02:57patients are eligible for surgery,
02:57 --> 02:59it's often a good thing because
02:59 --> 03:01we're often treating people for
03:01 --> 03:04curative intent. Is that right?
03:04 --> 03:06Yes, and that's the same
03:06 --> 03:09for lung cancer as well.
03:09 --> 03:11Surgery for lung cancer typically is
03:11 --> 03:15most helpful for patients who are in
03:15 --> 03:17their early stage of lung cancer.
03:18 --> 03:22And so historically talk a little bit
03:22 --> 03:25about how lung cancer was managed
03:25 --> 03:26surgically.
03:26 --> 03:30Sure, lung cancer had been managed
03:30 --> 03:33with what's called a thoracotomy.
03:33 --> 03:36And a thoracotomy is a large
03:36 --> 03:40incision on the side of the chest,
03:40 --> 03:44usually about 6 inches or so long and
03:44 --> 03:48through that skin incision the access is
03:48 --> 03:51in between the ribs and those
03:51 --> 03:53are spread open in order to
03:53 --> 03:56access the lung and the lung
03:56 --> 03:58cancer to remove the tumor.
03:59 --> 04:02And so tell us more. I mean,
04:02 --> 04:04it sounds like that's a pretty big operation.
04:04 --> 04:06You're in the hospital
04:06 --> 04:08and somebody is making this large cut
04:08 --> 04:10in your chest and spreading ribs
04:10 --> 04:12and taking out part of your lung.
04:12 --> 04:14What does that feel like or look
04:14 --> 04:16like from a patient perspective?
04:16 --> 04:18How long are you in hospital?
04:18 --> 04:20Does that mean that you're
04:20 --> 04:21on a breathing tube?
04:21 --> 04:23Does that mean that you're in ICU?
04:23 --> 04:24Give us more of a sense of
04:27 --> 04:29what that looks like.
04:29 --> 04:35Sure, so overtime up till modern day when
04:35 --> 04:38patients require thoracotomy incision
04:38 --> 04:43for their lung cancer the hospital stay
04:43 --> 04:47is usually between three to five days.
04:47 --> 04:50And patients are usually in a step
04:50 --> 04:53down unit for monitoring their vital
04:53 --> 04:57signs and the majority of the hospital
04:57 --> 05:00stay is making sure their pain is
05:00 --> 05:03well controlled so that they can
05:03 --> 05:06deep breathe well and cough well
05:06 --> 05:09and recover after such a big operation.
05:10 --> 05:13But I understand that now,
05:13 --> 05:17just like many surgeries we think
05:17 --> 05:19about gallbladder surgery that used
05:19 --> 05:23to be done with a big cut as well.
05:23 --> 05:26Where now it can be done with
05:26 --> 05:303 little holes and some cameras.
05:30 --> 05:32What many people in the lay
05:32 --> 05:34public call little telescopes
05:34 --> 05:36where the gallbladder can be
05:36 --> 05:38removed through tiny incisions,
05:38 --> 05:40has lung cancer surgery
05:40 --> 05:42progressed to that point?
05:42 --> 05:45Yes, absolutely,
05:45 --> 05:47so that's minimally invasive lung
05:47 --> 05:50surgery starting in about the 90s,
05:50 --> 05:54there was the progress in terms of
05:54 --> 05:56minimally invasive instrumentation.
05:56 --> 05:59Just as you had mentioned
05:59 --> 06:01for Gallbladder surgery,
06:01 --> 06:02these laparoscopic instruments
06:02 --> 06:05were modified for the chest,
06:05 --> 06:09and so what that looks like
06:09 --> 06:13today is usually a camera
06:13 --> 06:16and it's usually about a 5 millimeter
06:16 --> 06:20or less than half an inch in diameter
06:20 --> 06:23that gets projected onto
06:23 --> 06:27a typical HD screen in the OR
06:27 --> 06:30through one incision and there
06:30 --> 06:33are three other small incisions,
06:33 --> 06:35again, usually quite small,
06:35 --> 06:39about a centimeter and through these
06:39 --> 06:42total of four incisions we use that
06:42 --> 06:45technique to remove lung cancer,
06:45 --> 06:50where previously we had done a thoracotomy.
06:50 --> 06:52So it sounds like that would
06:52 --> 06:54potentially be much easier
06:54 --> 06:56on patients, much less pain.
06:56 --> 06:58So what does that picture look like?
06:58 --> 07:02I mean, do patients go home sooner?
07:04 --> 07:07It doesn't sound like you'd need to
07:07 --> 07:10spread ribs and those kinds of things,
07:10 --> 07:13so pain is a contrasting picture to
07:13 --> 07:16what that looks like as
07:16 --> 07:17opposed to a thoracotomy.
07:17 --> 07:20Sure, so when patients undergo
07:20 --> 07:22this type of surgery called VATS
07:22 --> 07:25or video assisted thoracoscopic surgery
07:27 --> 07:30because of the smaller incisions,
07:30 --> 07:33patients do have less pain.
07:33 --> 07:35They do recover in the hospital
07:35 --> 07:39and at home much more easily,
07:39 --> 07:42and their quality of life and a
07:42 --> 07:45return to work is sooner as well
07:45 --> 07:48and from a variety of studies
07:48 --> 07:51that have been done overtime
07:51 --> 07:55this has shown to be the case compared
07:55 --> 07:58to open thoracotomy cases and
07:58 --> 08:00so, whereas thoracotomy patients
08:00 --> 08:03spend about three to four days
08:03 --> 08:06in hospital, in a step down,
08:06 --> 08:10what happens to patients who are
08:10 --> 08:12treated with vats usually does
08:12 --> 08:16result in a reduction of the
08:16 --> 08:19hospital stay from one to two days,
08:19 --> 08:22depending on various other factors.
08:22 --> 08:25But the reduction in the hospital
08:25 --> 08:28stay is usually from reduction in pain.
08:33 --> 08:36If we take a step back and we think
08:36 --> 08:39about it from the health care system,
08:39 --> 08:43Is 1 procedure cheaper than the other?
08:43 --> 08:46I mean, I can see that you know
08:46 --> 08:48thoracotomies likely have increased
08:48 --> 08:51costs due to increased length of stay,
08:51 --> 08:55but on the other hand there's
08:55 --> 08:57capital equipment and technology
08:57 --> 09:00that adds up to cost as well.
09:00 --> 09:02Have people looked at
09:02 --> 09:04differences between vats and
09:04 --> 09:06thoracotomy in terms of cost?
09:06 --> 09:09Yes, there have been several
09:09 --> 09:11studies and the general
09:11 --> 09:15conclusion from these is that because of
09:15 --> 09:19reduced hospital stay,
09:19 --> 09:22the minimally invasive approach,
09:22 --> 09:25is less costly.
09:25 --> 09:28But as you were saying,
09:28 --> 09:30the hospital of course has to
09:30 --> 09:33invest in the capital upfront,
09:33 --> 09:36and this is also similar
09:36 --> 09:39to another minimally invasive
09:39 --> 09:41instrument, the robotic approach.
09:41 --> 09:44Again, there is investment upfront on
09:44 --> 09:47the hospital and the health system,
09:47 --> 09:51but overtime there is reduced cost.
09:51 --> 09:54For patients, when patients
09:54 --> 09:57are looking at paying out of
09:57 --> 10:01pocket for these procedures,
10:01 --> 10:03or if they have a particular percentage
10:03 --> 10:06that they have to pay in terms of
10:06 --> 10:08copays and those kinds of things,
10:08 --> 10:11is there a difference in terms
10:11 --> 10:13of patient cost as well?
10:14 --> 10:17I actually do not have a good idea on
10:17 --> 10:21the cost from the patient standpoint.
10:21 --> 10:25I do believe that as the healthcare
10:25 --> 10:28system has savings on this that it
10:28 --> 10:31would get passed on to the patient,
10:31 --> 10:33but I I don't know.
10:33 --> 10:36Yeah one would
10:36 --> 10:38certainly imagine so and
10:38 --> 10:41VATS procedures now have become
10:41 --> 10:43fairly widely accepted, right?
10:43 --> 10:46So most insurances should cover
10:46 --> 10:48VATS procedures just as
10:48 --> 10:50they would thoracotomies?
10:50 --> 10:52Yes, absolutely.
10:52 --> 10:54All insurance companies do cover
10:54 --> 10:56VATS the minimally invasive
10:56 --> 10:58approach compared to thoracotomy.
10:58 --> 11:00So are there any reasons why
11:00 --> 11:04a particular patient may not opt for a
11:04 --> 11:06vats procedure versus a thoracotomy,
11:06 --> 11:09are there patients that you would
11:09 --> 11:12kind of lean more towards doing
11:12 --> 11:15things as we would say old school.
11:16 --> 11:20As you can imagine for the
11:20 --> 11:22minimally invasive approach that
11:22 --> 11:25requires instrumentation that is
11:25 --> 11:28small in order to fit through
11:28 --> 11:32these small incisions that we use,
11:32 --> 11:37and so vats is used for
11:37 --> 11:39relatively straightforward lung
11:39 --> 11:41cancer operations. For operations
11:41 --> 11:44that are more complicated,
11:44 --> 11:48for example, larger tumor or if the
11:48 --> 11:51patient has received chemotherapy
11:51 --> 11:56and or radiation where there is more
11:56 --> 11:59scarring due to those treatments
11:59 --> 12:02that does make it more difficult
12:02 --> 12:06to use the vats instruments.
12:07 --> 12:08It's not totally unreasonable,
12:08 --> 12:11but it is certainly easier on the
12:11 --> 12:14surgeon to do the operation through
12:14 --> 12:17a thoracotomy for those scenarios.
12:17 --> 12:19And does it
12:19 --> 12:21take special kind of training to
12:21 --> 12:25be able to do vats procedures,
12:25 --> 12:27or are most lung cancer
12:27 --> 12:30surgeons pretty adept at both?
12:31 --> 12:33In today's thoracic surgery
12:33 --> 12:35practices, almost all,
12:35 --> 12:37at least in the United States,
12:37 --> 12:39almost all thoracic surgeons
12:39 --> 12:42have been trained in vats.
12:42 --> 12:44In addition to the traditional
12:44 --> 12:45thoracotomy approach,
12:45 --> 12:47and so most hospitals
12:47 --> 12:49then have this technology
12:49 --> 12:51that patients would be able
12:51 --> 12:53to avail themselves of.
12:53 --> 12:57It's not like you have to go to,
12:57 --> 12:58you know some place special
12:58 --> 13:01to get that. Is that right?
13:02 --> 13:05Exactly most hospitals would have this.
13:05 --> 13:06The instrumentation for minimally
13:06 --> 13:10invasive vats, yes.
13:10 --> 13:13We are going to take a very short break
13:13 --> 13:14for a medical minute.
13:14 --> 13:17Please stay tuned to learn more
13:17 --> 13:20about surgical management of thoracic
13:20 --> 13:22malignancies.
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13:28 --> 13:32Learn more at astrazeneca-us.com.
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13:43 --> 13:45but thanks to earlier detection,
13:45 --> 13:46noninvasive treatments,
13:46 --> 13:47and novel therapies,
13:47 --> 13:50there are more options for patients to
13:50 --> 13:53fight breast cancer than ever before.
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13:55 --> 13:57mammogram beginning at age 40 or
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14:05 --> 14:07breast screening by significantly
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14:19 --> 14:22You're listening to Connecticut Public Radio.
14:22 --> 14:23Welcome
14:23 --> 14:25back to Yale Cancer Answers.
14:25 --> 14:27We are discussing the surgical
14:27 --> 14:29management of thoracic malignancies,
14:29 --> 14:32so Andrew right before the break
14:32 --> 14:35we were talking a lot about how
14:35 --> 14:37historically lung cancer had been
14:37 --> 14:39taken out with thoracotomies,
14:39 --> 14:42which are large cuts people needed
14:42 --> 14:45to stay in hospital several days in
14:45 --> 14:49a in a step down unit and how really
14:49 --> 14:52things have evolved towards vats or
14:52 --> 14:54video assisted thoracic surgery
14:54 --> 14:59where you can use kind of small incisions,
14:59 --> 15:03a little camera that can go in and
15:03 --> 15:06remove these, ultimately reducing pain,
15:06 --> 15:09reducing length of stay and you had
15:09 --> 15:11mentioned before the break that
15:11 --> 15:13there's yet another technology
15:13 --> 15:16in terms of robotic surgery.
15:16 --> 15:17Tell us more about that?
15:17 --> 15:22The Intuitive company
15:22 --> 15:26produced a robotic technology in the 2000s,
15:26 --> 15:29and that's what is commonly
15:29 --> 15:32known today as the Davinci robot,
15:32 --> 15:36so that is another minimally invasive
15:36 --> 15:39tool that thoracic surgeons can use
15:39 --> 15:42to surgically treat lung cancer.
15:43 --> 15:46Tell us more about
15:46 --> 15:49this because the whole concept of
15:49 --> 15:52you know robots doing your surgery
15:52 --> 15:56for some might seem really high tech
15:56 --> 15:58and really innovative and for others,
15:58 --> 16:01might seem really kind of frightening
16:01 --> 16:04because you kind of like the idea
16:04 --> 16:07of a human actually being there
16:07 --> 16:09to manage your cancer.
16:09 --> 16:13So how exactly does this robot
16:13 --> 16:15or robotic surgery work?
16:15 --> 16:17Is it really like there's
16:17 --> 16:20a small little robot
16:20 --> 16:24that goes in there and does your surgery
16:24 --> 16:26during robotic lung cancer cases?
16:26 --> 16:30We have the robot arms at the
16:30 --> 16:34patients table and a few feet away
16:34 --> 16:36the surgeon sits at a console
16:36 --> 16:40where they view the images from
16:40 --> 16:43the robotic camera and they use
16:43 --> 16:46an instrumentation to remove the
16:46 --> 16:50robotic arms that way so the surgeon
16:50 --> 16:53is certainly in the room next to
16:53 --> 16:56the patient with the robotic arms
16:56 --> 16:59at the patient doing the
16:59 --> 17:02actual work inside the chest. So
17:02 --> 17:05the important key is that the surgeon
17:05 --> 17:08is really the brain operating
17:08 --> 17:11the robot and the robot's arms.
17:11 --> 17:14These robots are not
17:14 --> 17:15operating independently of
17:15 --> 17:19a surgeon who is there, is
17:19 --> 17:21that right?
17:21 --> 17:23Absolutely, the robot is not autonomous.
17:23 --> 17:27The robot in each and every movement is
17:27 --> 17:30directed by the surgeon.
17:30 --> 17:33So why is this any different
17:33 --> 17:36then where
17:36 --> 17:39you're still working with instruments.
17:39 --> 17:42Looking at an image on
17:42 --> 17:45a screen, both are certainly
17:45 --> 17:46minimally invasive
17:46 --> 17:52approaches with the robotic technology.
17:52 --> 17:55Formed through four small incisions,
17:55 --> 18:00each are between 8 to 12 millimeters in size
18:00 --> 18:04and there there is an additional incision.
18:04 --> 18:08A small incision that's made for
18:08 --> 18:11the assistant at the bedside to
18:11 --> 18:15assist during the operation as well.
18:15 --> 18:19So both certainly do result in less pain
18:19 --> 18:23in the postoperative period then and
18:23 --> 18:24open thoracotomy,
18:24 --> 18:27the main advantages for the
18:27 --> 18:30robotic approach is number 1,
18:30 --> 18:33the improved visualization because of
18:33 --> 18:37the robotic camera and the technology
18:37 --> 18:39that went into developing that
18:39 --> 18:43it does give you a 3 dimensional
18:43 --> 18:46view of the surgical field.
18:46 --> 18:49Sort of like you were actually
18:49 --> 18:52inside the chest looking at
18:52 --> 18:54these structures and doing
18:54 --> 18:56the surgery that way.
18:56 --> 18:58In addition to that,
18:58 --> 19:00it's certainly more ergonomic as well,
19:01 --> 19:04and if it's easier on the surgeon,
19:04 --> 19:06that certainly helps the operation
19:06 --> 19:09go well and for the patients that
19:09 --> 19:11have a better outcome.
19:12 --> 19:17So you know I can appreciate that
19:17 --> 19:20the camera is a little bit better.
19:20 --> 19:23The arms are a little bit better
19:23 --> 19:27in terms of their ergonomics and
19:27 --> 19:30potentially the degree to which they are
19:30 --> 19:34flexible in moving in various directions,
19:34 --> 19:36which can make the operation
19:36 --> 19:39easier to perform.
19:39 --> 19:42But there must be added cost
19:42 --> 19:44to this whole system
19:44 --> 19:48over VATS which as you mentioned,
19:48 --> 19:50is pretty universally available.
19:50 --> 19:51Certainly
19:51 --> 19:55the robotic system has a greater capital
19:55 --> 20:00costs for the hospital for the health system.
20:00 --> 20:03And in addition to the actual tools,
20:03 --> 20:07the actual robot and the consoles there
20:07 --> 20:10does need additional training
20:10 --> 20:14on the side of the staff as well.
20:14 --> 20:17For example, a person at the bedside
20:17 --> 20:20being another surgeon or resident
20:20 --> 20:22physician assistant to assist
20:22 --> 20:25and in addition to that person
20:25 --> 20:27of course, the nursing staff
20:27 --> 20:31in the room to help set up the
20:31 --> 20:34robotic instrumentation for the
20:34 --> 20:38operation and not to mention in scenarios
20:38 --> 20:42where an acute issue needs to be dealt with,
20:42 --> 20:45the whole team needs to be aware of
20:45 --> 20:49how to maneuver things so that they
20:49 --> 20:53could be dealt with without the robot,
20:53 --> 20:58and so there are
20:58 --> 21:03many things that are required for
21:03 --> 21:08a surgeon to perform robotic thoracic
21:08 --> 21:13surgery as part of their practice.
21:13 --> 21:19One of the ideas behind the
21:19 --> 21:23technology is also to allow surgeons
21:23 --> 21:29who have perhaps not trained in vats
21:29 --> 21:33to be able to perform a minimally
21:33 --> 21:35invasive approach a lot easier.
21:37 --> 21:41As both the vats approach and the
21:41 --> 21:44robotic approach do have learning
21:44 --> 21:46curves associated with them,
21:46 --> 21:49the learning curve from open thoracotomy
21:49 --> 21:53to robotic approach is an easier
21:53 --> 21:55minimally invasive approach to learn.
21:57 --> 22:00And so from the patient's standpoint,
22:00 --> 22:03if you compare vats to robotic surgery,
22:03 --> 22:06is there any difference in terms of
22:06 --> 22:11length of stay or pain, or return to work?
22:13 --> 22:15There have been and continue
22:15 --> 22:19to be studies looking at this.
22:19 --> 22:22And other factors as well.
22:22 --> 22:26For example, the length of state there is
22:26 --> 22:30a trend towards decrease length of stay.
22:30 --> 22:34There is a trend towards decrease pain,
22:34 --> 22:39but so far nothing that is
22:39 --> 22:40statistically significant.
22:40 --> 22:43The other factor to consider
22:43 --> 22:46is from a cancer operation.
22:46 --> 22:49If any of these minimally invasive
22:49 --> 22:52approaches are similar or different
22:52 --> 22:55than the traditional approach in
22:55 --> 22:59terms of cancer survival and so far
22:59 --> 23:02both events in the robotic approach
23:02 --> 23:06do not have a difference between them
23:06 --> 23:09or with the traditional
23:09 --> 23:13approach in terms of cancer survivorship.
23:14 --> 23:17And is robotic surgery covered by all
23:17 --> 23:20insurance the way vats is and would
23:20 --> 23:23be the cost to the patient and or
23:23 --> 23:26to the hospital system be the same.
23:27 --> 23:30Most insurance companies do recognize
23:30 --> 23:33robotic surgery and it is covered.
23:33 --> 23:37I don't know the specifics of how
23:37 --> 23:40the comparison between a robotic
23:40 --> 23:42approach versus a vats approach
23:42 --> 23:46in terms of the final cost to the
23:46 --> 23:49patient.
23:49 --> 23:52So how do you make the decision between whether
23:52 --> 23:55to offer patients a VATS procedure
23:55 --> 23:58versus a robotic procedure?
23:58 --> 24:04I think the main thing is from the surgeon
24:04 --> 24:07experience and training standpoint.
24:07 --> 24:13I think when patients are seeing a thoracic
24:13 --> 24:18surgeon and discussing surgical options
24:18 --> 24:21mostly, a surgeon has trained and is
24:21 --> 24:24comfortable with the vats approach and then
24:24 --> 24:27I think that is appropriate of course.
24:27 --> 24:30And if they are more comfortable
24:30 --> 24:33and have trained in the robotic
24:33 --> 24:36approach then that is fine as well.
24:36 --> 24:39I think the main thing for
24:39 --> 24:42patients to be aware of is that the
24:42 --> 24:44thoracic surgeon have some experience
24:45 --> 24:47in a minimally invasive approach,
24:47 --> 24:50whether it's vats or robotic.
24:50 --> 24:54So that their length of stay is less,
24:54 --> 24:56their pain is less.
24:56 --> 24:59Their return to work is sooner,
24:59 --> 25:03and there are also less complications
25:03 --> 25:05after surgery compared to the
25:05 --> 25:08traditional open approach as well.
25:10 --> 25:13Do all hospitals have robotic
25:13 --> 25:15surgery or when we
25:15 --> 25:19were talking about VATS you had kind of
25:19 --> 25:21mentioned that this is pretty ubiquitous.
25:21 --> 25:24Most people have trained in vats and
25:24 --> 25:28so it would be something that would be
25:28 --> 25:31very amenable no matter where you were.
25:31 --> 25:34It doesn't sound like that's necessarily
25:34 --> 25:36the case for robotic surgery.
25:36 --> 25:39Is that right?
25:39 --> 25:41Not all hospital systems have the Davinci
25:41 --> 25:44technology this is something
25:44 --> 25:48that is becoming more common and
25:48 --> 25:51my understanding from a financial
25:51 --> 25:54standpoint is that the company
25:54 --> 25:57does work with the hospital in the
25:57 --> 26:01health system to come up with a
26:01 --> 26:05suitable plan so that they can offer
26:05 --> 26:08the robotic technology to their
26:08 --> 26:12patients and to save on the cost.
26:12 --> 26:16And that cost savings,
26:16 --> 26:17hopefully does get passed
26:17 --> 26:20on to the patient as
26:20 --> 26:23well, and you had
26:23 --> 26:25talked about kind of deciding between
26:25 --> 26:28vats versus robotic surgery you
26:28 --> 26:31really mentioned that it had to do
26:31 --> 26:34primarily with the surgeons comfort.
26:34 --> 26:37If surgeons are comfortable with both
26:37 --> 26:39techniques and have been trained in both,
26:39 --> 26:41are there particular patient
26:41 --> 26:43characteristics that would lean
26:43 --> 26:46you more one way or another?
26:46 --> 26:51Yeah, for the robotic approach
26:51 --> 26:55the instruments tend to be longer
26:55 --> 26:58and sturdier than the vats
26:58 --> 27:01instruments and so for patients
27:01 --> 27:04for example, who might be morbidly
27:04 --> 27:07obese
27:07 --> 27:12it would be easier for the surgeon to do
27:12 --> 27:17the surgery robotically versus by vats.
27:17 --> 27:21And there are other scenarios
27:21 --> 27:25from a tumor standpoint as well.
27:25 --> 27:27With the robotic approach,
27:27 --> 27:31the ability to do very fine
27:31 --> 27:34detailed dissection and surgery
27:34 --> 27:39is enhanced compared to the vats
27:39 --> 27:43approach due to the improved camera,
27:43 --> 27:47improved ergonomics and the ability
27:47 --> 27:50for the robotic instrumentation to
27:50 --> 27:52have greater degrees of freedom
27:52 --> 27:54with the instrumentation,
27:54 --> 27:58so for those types of tumors as well,
27:58 --> 28:01those are
28:01 --> 28:05better performed with robotic versus vats.
28:05 --> 28:08Doctor Andrew Dhanasopon is an
28:08 --> 28:09assistant professor of thoracic
28:09 --> 28:12surgery at the Yale School of Medicine.
28:12 --> 28:13If you have questions,
28:13 --> 28:14the address is canceranswers@yale.edu
28:14 --> 28:16and past editions of the program
28:16 --> 28:18are available in audio and written
28:18 --> 28:20form at yalecancercenter.org.
28:20 --> 28:22We hope you'll join us next week to
28:22 --> 28:25learn more about the fight against
28:25 --> 28:27cancer here on Connecticut Public Radio.

Information

VATS and Surgical Management of Thoracic Malignancies with guest Dr. Andrew Dhanasopon January 31, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095