 If I have lung cancer, will I definitely need surgery? There's several different types of lung cancer. There's several different stages of lung cancer and there's several different treatments for lung cancer depending upon the stages and the type of lung cancer one has. All lung cancers need to be treated. Some of them are going to require surgery, some of them will require radiation therapy, some of them will require chemotherapy or immunotherapy or targeted therapy. What are the different types of surgeries for lung cancer patients? So the two main platforms for lung cancer surgery are open and minimally invasive. The open technique makes big incisions and has a lot of detriments to it. The first is being significant amount of pain, another one being a long hospitalization. After that, patients aren't really ready to go back to work for a long period of time. It has a difficulty just lifting their arm for several months after surgery. Not only that, but getting treatment after surgery, meaning chemotherapy or radiation therapy, normally has to be delayed a significant amount of time for the healing process to complete prior to getting said treatment. Now the good news here at NYU Winthrop is that we specialize in minimally invasive platforms. The two different types, meaning vats or video-assisted thoracic surgery, the other being robotics, we do every day. We specialize in robotics, but we also do vats on occasion. The benefit of robotics as well as vats is we use very small incisions and we're able to do a full cancer operation through those small incisions. The benefit of the minimally invasive platform is multi-fold. One is that there's significantly less pain, another is the patients are out of the hospital extremely quickly. Almost all of our patients after a major operation go home in two days. Maybe on the third day they'll go home, but when they go home, there's no restrictions. They lift what they want to do, they do what they want to do. They can start their treatment if needed after surgery at any period of time. They could start chemotherapy or radiation therapy within a week of surgery if it was necessary. There's no holding back on healing processes because our incisions are less than an inch in size. They heal very quickly and there's no detriment to starting those treatments right away. Does someone with lung cancer need to have their entire lung removed? That's a great question. Over the years, we've found that there are various different techniques for doing a proper lung cancer operation. Years ago when lung cancer surgery began, the feeling was that you needed to take the entire lung out. An entire lung on the right side would be a right pneumonectomy. On the left side would be a left pneumonectomy. That was how all cancer treatment for lung cancer was done years ago. That gradually progressed into doing what's called low-bectomies. Currently the gold standard for lung cancer surgery is doing a formal low-bectomy, meaning that you take the lobe of the lung that the cancer is in out. On the right side, you have three lobes. You have a right upper lobe, a right middle lobe, and a right lower lobe. So if there's a cancer in the right lower lobe, we would normally take out the right lower lobe. On the left side, there's two lobes. There's an upper lobe and a lower lobe. So if the cancer is in the upper lobe, we would take out the left upper lobe. But things have progressed again and we have different types of lung cancers. Some of them are not very aggressive. And we found that, you know what, maybe you don't have to take out the entire lobe. Maybe you could do what's called a segmentectomy. Now a segmentectomy is basically taking out the segment of the lobe that the lung cancer is in. And there's various different numbers of segments in each of the lobes of your lung. So if you have a patient with a lung cancer in the superior segment of the right lower lobe, and it's not an aggressive cancer, well we can save the vast functionality of the lower lobe by just taking out the segment that the cancer is in, a superior segmentectomy. That acts as a real good cancer operation and preserves the patient's lung function so they don't have any detriments after the surgery. How does robotic surgery work and what are the benefits? Well there's a question that a lot of people don't understand. And a lot of people think that for robotic surgery, basically there's a robot operating on them and the surgeon really isn't doing anything, which is just not the case. With robotic surgery you basically have robotic arms which we place inside the patient's chest for lung surgery. And I'm at a console right next to the patient and I manipulate those arms to do the surgery that I need to have done. So it's basically mimicking my movements. It doesn't do anything on its own, it only does what I do. And in that way it's a very safe procedure. It's basically my own hands, it's just not my hands. My hands are being replaced by robotic small instruments that are able to get inside the chest cavity with very small incisions and do very precise surgery. The optics are extraordinary. I see three-dimensionally just like I do right now and I actually have the ability to magnify what I'm looking at. So I magnify where I'm operating ten times. So it's almost like I'm taking a look in with a telescope and zeroing in on the procedure I'm doing and the operation I'm doing and what I'm operating on and it enables me to do something that I just wouldn't otherwise be able to do. The robot enables me to do a procedure through very small incisions that I would just never be able to do on my own, would never be able to do with just a simple video-assisted thoracic surgical platform but utilizing the robot, it lets me do that. How the precise nature of the robotic arms and the technology allows me to see one millimeter vessels and have instruments that could dissect around those vessels without injuring them. This is something I couldn't do with an open technique or that's technique. And by doing that, it makes it a safer operation than either of the other two because I see everything. I see any type of abnormalities that otherwise I might not be able to see and it makes the operation safer for my patients. Therefore, it's shown that we use much less blood for our patients after surgery. Our lymph node dissections, which are a major part of our cancer operations, are significantly better with robotics as opposed to open techniques as well as bad techniques. And these things all give the patient a better cancer operation and that's why the majority of our patients are cured with surgery and never require chemotherapy or radiation therapy. Typically, who would be a candidate for robotic lung surgery? Here at NYU Winthrop, almost everybody is a candidate for robotic surgery and I don't just say that because this is what we do but we find benefit almost all the time with a robotic platform. There are some people who might have a type of a tumor that can't be taken out due to its sheer size but we find that the majority of people with lung cancer, no matter the size that they present with, we can take them out with a minimally invasive platform and give them the benefits of having a robotic procedure performed. Not only do we do lung resections or lobectomies or wedge resections or segmentectomies or even pneumonectomies with a robot, but we also do complex chest wall resections as well as complex lung resections where we reconstruct the airways, we reconstruct the chest wall. We also take out all types of mediastinal tumors as well with the robot and posterior mediastinal which would include esophageal cancer. We do that robotically as well giving our patients the benefit of a minimally invasive procedure and getting out of the hospital in a timely fashion. Esophageal cancer surgery which has been around for a long time, most patients are going home 10, 12, 14 days after surgery. Our robotic patients that have the procedure, they're usually home on day five or day six and they're eating almost a regular meal very soon after the operation. What is recovery like after robotic lung surgery? That's a question almost everybody asks and it's kind of hard to say precisely what your recovery is going to be like because everybody is different and everybody's surgery is different and for the most part I can answer it this way. Utilizing robotics in a minimally invasive platform, patients are back doing what they want to do pretty quickly. Pain issue is not that much when it comes to robotic surgery patients after a couple of weeks are not using anything more than some Tylenol or some aspirin or some ibuprofen and within a couple of days and a couple of weeks there's almost no restrictions and people are doing anything they want to do. Our vast majority of patients are back to work within a week or so and they're back at full duty. They're not a light duty, they're not lifting only a couple of pounds. They do what they want to do and they do their job and I think they all benefit from having a minimally invasive robotic platform for their surgery because it allows them to do that. What are the potential risks and side effects of lung cancer surgery? There's a myriad of different complications that can occur after surgery and if you could think about something that can happen there's a possibility it can happen. The key here is to minimize those risks. The benefit of the robot is that we find that we decrease the risk of any type of complication after lung surgery utilizing this platform. One of the benefits of it is obviously using a minimally invasive platform. Minimally invasive platforms have been shown through significant numbers of literature written throughout the world that minimally invasive platforms decrease complications and therefore patients do better. But complications do happen and fortunately usually they're minor. The majority of them are just patients who have to stay in the hospital for a prolonged period of time because of one situation or another but once they go home there's really no residual effects and they go about their business in just a delayed fashion. But regardless complications can happen and that's another reason why we make sure everybody is optimized for surgery prior to going to surgery. That's taken care of by their medical team whether it's their cardiologist their internal medicine doctor or their family practice doctor. We want to make sure everybody is optimized for surgery therefore that decreases their risk for complication or a problem after surgery. As for issues after surgery which are really not complications but issues they might face when they go home like going up the steps well those are issues that we look into. Patients who have lung surgery are having lung removed and therefore some of their breathing ability is taken away. But we have breathing tests done prior to surgery where we know that at the end of the operation they're going to have enough lung function to last them a lifetime. Maybe they'll get a little winded initially after surgery going up the stairs but it's understood and the patients understand that and we know it's going to get better after they heal. Why should I choose NYU Winthrop to have my robotic lung surgery? NYU Winthrop offers all the modalities available for patients with lung cancer and depending upon what type of lung cancer you have and how aggressive it is and what stage it is we basically will come up with a plan for you. An individualized plan during our tumor board which we have every week all the specialties are together radiation, oncology, radiology, pathology and surgery and we individualize everybody's treatment plan to that person and that person's tumor. If you have any other questions regarding the thoracic surgery program here at NYU Winthrop please call us at 1-866-WINTHRUP or visit us online at NYUWINTHRUP.org