When Dr. Amir Abolhoda recently performed robot-assisted lung cancer surgery at UC Irvine Medical Center the first procedure of its kind in Orange County it marked the latest leap in the fast-evolving field of robotics.

The minimally invasive procedure successfully removed a cancerous lobe from the lung of a 52-year-old patient and sampled nearby lymph nodes for cancerous cells entirely by robotic-controlled instruments. It was a high-tech extension of the surgeon’s touch.

The result was maximum precision with minimal pain, and a phenomenally quick recovery time. 

“The patient was able to leave the hospital in two days,” Abolhoda said. 

At City of Hope, an entire kidney was removed using the robotic da Vinci Surgical System, through a single 2.5-inch incision. The patient was home and feeling fine three days later. 

“Single-incision robotic surgery is still in its infancy,” City of Hope surgeon Clayton Lau said. “However, in the future, robotics will probably use multiple arms to go through one port.”

Cancer treatment has indeed come a long way and Southern California is ground zero for many of the most revolutionary and advanced cancer procedures, performed by staffs of internationally acclaimed physicians and surgeons at world-class medical centers.

A cut above

Whereas robotics such as the revolutionary da Vinci system help surgeons precisely target malignant masses and reduce complications, blood loss and side effects for patients, other breakthroughs such as the CyberKnife system avoid surgery altogether.

An entirely noninvasive alternative to surgery, CyberKnife targets various forms of cancer by delivering high doses of radiation to tumors with pinpoint accuracy, sparing healthy tissue.

An effective option for a variety of complex cancers including brain, lung and prostate, CyberKnife involves no cutting whatsoever. It’s a painless procedure, relatively free of side effects and requires no hospitalization or anesthesia. And patients can immediately return to their daily activities. The Pasadena CyberKnife Center (www.pasadenacyberknife.com), currently has the only Cyberknife VSI system in Los Angeles area.

If surgery is required, intraoperative radiotherapy can bombard isolated areas with radiation while they’re still exposed and the patient remains under anesthesia.

Exciting advancements in post-operative treatments and cancer vaccines have recently emerged, as well. Cedars-Sinai developed an experimental immune-based therapy that has more than doubled the median survival rate for patients diagnosed with aggressive brain tumors. 

“Brain tumors evade the immune system to survive, and the vaccine is intended to alert the immune system to the existence of cancer cells and activate a tumor-killing response,” said Dr. Keith L. Black, chair and professor of Cedars-Sinai’s Department of Neurosurgery.

State of the art

Launched just 10 years ago, the pioneering da Vinci Surgical System was first used exclusively for prostate surgery, but now assists in procedures to remove many types of cancer, including head and neck, lung, esophageal, kidney, gynecologic and colorectal. 

It’s a perfect collaboration of surgical skill and the latest technology. Surgeons guide the procedure while viewing a high-resolution 3-D image of the surgical site through a camera. Miniaturized instruments inserted into the body through small incisions are controlled by robotic arms operated by the surgeon’s hand movements.

“Our da Vinci system allows surgeons to sit aside the patient at computer consoles and perform procedures by a remote process that employs highly detailed imaging and a high degree of precision,” said Dr. Timothy Wilson, head of the urology department at City of Hope. “It’s much less invasive than traditional surgery, with lower risk of infection and less blood loss.”

City of Hope and the developers of the da Vinci system, Intuitive Surgical, recently developed a process that causes healthy tissue to glow, enabling the surgeon to more precisely target malignant masses while minimizing damage of surrounding tissue. A dye (called indocyanine green) is infused into the patient’s blood, and an attachment allows the surgeon to shine a light on the area of the tumor.

For example, before removing a kidney tumor, the indocyanine green lights up the normal kidney tissue as well as blood vessels that feed it with a bright green glow, dramatically isolating the dark tumor. 

“The fluorescent imaging allows for real-time identification of the blood vessels feeding the kidney, and we are able to clamp off only a segmental artery to the kidney tumor,” said Dr. David Josephson, director of urologic surgery at City of Hope. “This allows us to perform a meticulous and precise dissection of the tumor without restricting blood flow to the kidney, so we avoid any long-term damage to the healthy tissue.” 

The newest generation of robotics, the da Vinci Si HD, allows two surgeons to work together on separate consoles, able to switch control from one to the other at any time during complex procedures. It can be a highly effective training tool for less-experienced surgeons, Wilson said. 

“An experienced surgeon can direct a newcomer from a separate console,” Wilson said. “Our da Vinci technology even allows [the experienced surgeon] to sit at a PC in his office and show the other surgeon exactly where to cut by tracing the outline on the monitor screen.”

Bob Young, Custom Publishing Writer