Two robots, Firefly and a dye work in concert to fight lung cancer

Northwestern Medicine Central DuPage Hospital in Winfield is integrating three cutting-edge technologies - the daVinci robot, the Monarch robot, and Firefly fluorescence imaging - all in one operating room to precisely resect hard to reach lung nodules and preserve as much lung tissue as possible.

The benefits of robotic-assisted lung surgery include avoiding large incisions and spreading the ribs to remove cancerous tissue. However, if the nodule is difficult to see on imaging, surgeons often must remove more lung tissue than necessary, or may have to do an open surgery to palpably feel the nodule.

Benjamin J. Seides, MD, director of Interventional Pulmonology at Central DuPage, is using new technology, called the Auris Health Monarch Platform, to robotically navigate a bronchoscope deep to the periphery of the lung and very precisely mark the nodule.

"The Monarch Platform is portable. We roll it into the operating room, use the computer-assisted 3-D navigation to tag the nodule with a fluorescent dye. The da Vinci system is then docked and the surgeon can begin the surgery immediately," Dr. Seides said. "The two robots work beautifully together."

Using the da Vinci robot, the surgeon controls the instruments and camera, which are inserted through small incisions in the chest. This allows for viewing inside the chest using long robotic arms. The Firefly System enables the surgeon to switch between standard, visible light and near-infrared imaging during the procedure. When used in conjunction with the dye, tissue is highlighted in a green color.

"The ability to locate small, difficult to find nodules in the lung with the Monarch, remove them with the da Vinci, and then immediately determine whether that nodule is a cancer is an amazing accomplishment," said James Wade, M.D., thoracic surgeon at Northwestern Medicine Central DuPage Hospital.

"In the past, each one of these steps had to be performed on different days in different locations. Now, with the combination of specialized practitioners working together, using state of the art equipment, we are able to locate, diagnose and treat cancers all at once. It's a one-stop shop for the patient, which makes a world of difference."

60-year-old Bryan Sanzotti, of Winfield, quit smoking ten years ago, but made sure to undergo annual computerized tomography (CT) scans of his lungs due to his increased risk of lung cancer. A CT scan showed some small changes, but a positron emission tomography (PET) scan could not confirm if it was cancer. The only way to determine if the nodules were dangerous was to go in surgically and do a biopsy.

"Mr. Sanzotti had a ground glass nodule. They are less solid and appear hazy on a CT, making them difficult to differentiate from healthy lung tissue. In addition, it was in a tough spot and not easy to reach," Dr. Seides said.

Using the Monarch, Dr. Seides dye marked the nodule in the operating room and the surgeon took out a small wedge of the suspicious lung using the daVinci. A biopsy determined it was cancer and a left lower lobectomy was then performed.

"The da Vinci robot has revolutionized thoracic surgery. It allows the surgeon to precisely remove tumors deep inside the chest, both large and small, while minimizing the size of the incision normally required to accomplish this," said Dr. Wade. "This combination of precision and minimally invasive surgery provides both an excellent treatment option to remove the cancer and safe, speedy recovery of the patient."

The entire surgery took about four hours and Sanzotti went home after only three days in the hospital. Now he is back to riding his bike at least 15 miles two to three times a week.

"I do experience shortness of breath occasionally, but overall I feel good and am relieved they were able to get all of the cancer," Sanzotti said. "I was concerned when the doctors told me they needed to go in surgically to see what the mass was. But I'm familiar with the use of robotics and navigation for complex surgeries and felt confident my surgical team was using the best approach."

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