Our lungs are like an upside-down tree with many branches.
Before lung cancer surgery, the surgeon needs to dissect the veins, arteries, and bronchi in the lung tissue to distinguish them. But because of the complexity of the human body, almost everyone has different variations of blood vessels and bronchi in their lungs, and a cancerous lesion can grow on a small branch in this leafy tree.
It is not difficult to imagine the difficulty for the surgeon to accurately find and completely remove the lesion. The surgeon is like driving on a complex, unfamiliar road with many switchbacks, twisting and turning to find the right direction.
Thus, accurate localization of the lesion is critical. The smaller the lesion, the greater the requirement for precise localization. In most cases, the physician needs to determine the location of the lesion from the CT and “restore” the planar image to the stereotype in his or her mind, which is very difficult to pinpoint the lesion. So, is there a better way?
I. 3D reconstruction: GPS targeting of lesions
Since Hideo Kodama invented 3D printing in 1981, 3D localization has been widely used in medicine, and now we can use 3D reconstruction to achieve “GPS localization” of lung cancer.
Specifically, clinicians use imaging software to reconstruct a CT tomogram of the lung in three dimensions, which gives a true picture of the distribution of arteries, veins, and bronchi, so that they know which vessels and bronchi to cut before surgery. This is like installing a precise GPS navigation system for the surgery. It effectively reduces the surgeon’s miscalculations and reduces complications and surgical risks.
II. Magnetic navigation technology: drawing a road map to the lesion
In addition to 3D reconstruction, magnetic navigation technology is a “magic bullet” for accurately locating small pulmonary nodules.
Electromagnetic navigation technology is based on bronchoscopy, which uses CT and magnetic field navigation to create a “virtual route” to the lesion, along which the surgeon can follow to the lesion and retrieve a specimen of tumor tissue, while also injecting a fluorescent dye into the lesion to “mark” it for surgery.
3. Surgical robots: A surgeon’s delicate “hands”
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You may have heard of robotic surgery, and you may have wondered: if robots can do surgery, what do surgeons need to do? In fact, the robot works under the surgeon’s control.
The da Vinci-Robot Surgical System was developed in 1997 and approved by the FDA for clinical surgery in 2000. It provides the surgeon with a wide-angle, high-definition image, and the robotic arm can move 360° freely, completely surpassing the mobility of human joints, with better stability, finer movements, and no “hand tremors,” improving the safety of surgery. In short, the surgeon operates the robotic system with a level of dexterity that surpasses that of a human being to perform surgery on a lung cancer patient.
Fourteen studies conducted both domestically and internationally found that patients undergoing da Vinci robotic surgery required fewer postoperative blood transfusions, fewer lung leaks for more than 5 days, and shorter time with chest drains compared with television-assisted thoracoscopic surgery (VATS). Experts at the Shenyang Military General Hospital in China also found that patients in the robotic surgery group had less intraoperative bleeding and postoperative drainage, and higher 2-year progression-free survival and overall survival rates compared with VATS. A foreign analysis concluded that da Vinci robot-assisted complete lung cancer resection is safe and feasible and is expected to replace lumpectomy.
As lung cancer surgery continues to improve and high-tech “weapons” are introduced, there is only one constant: the most effective way to remove lung cancer while maximizing the patient’s quality of life. Perhaps in the near future, cancer will become a chronic disease that can be treated or survived for a long time.
To learn more about new trends in lung cancer surgery, read this article:
Co-authors: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Zheng Shaopeng Dr. Huang Lu Yu Dr. Xia Jin