Manu Sancheti, MD, FACS, Assistant Professor of Surgery at Emory School of Medicine and a Thoracic Surgeon at Emory St. Joseph Hospital and Director of Robotic Thoracic Surgery for Emory Healthcare talks about esophageal cancer and minimally-invasive robotic surgery.
Interview conducted by Ivanhoe Broadcast News in April 2018.
What does a Thoracic Surgeon do and what kind of patients do you operate on?
Dr. Sancheti: A thoracic surgeon primarily works on diseases of the chest. We’re trained to operate on the heart, on the lungs, on the esophagus, on the rib cage, on areas even in the upper abdomen and masses inside the chest as well.
Do you see cancer patients? What other types of patients, you were saying also hernias. Give us a list so we have an idea.
Dr. Sancheti: It’s primarily chest cancer so it’s going to be lung cancer, esophageal cancer and mesothelioma. It’s also what we call mediastinal masses which are masses in the front and middle of the chest and masses near the heart, like thymic cancers. Also non-cancer surgery such as rib/chest wall surgery, hiatal hernias, paraesophageal hernias, diaphragm surgery and some neck surgeries.
So up to this point when a patient needs surgery in these cases was it open surgery prior to this technology? Let’s talk about the technology and what kind of procedure you can do today.
Dr. Sancheti: Historically, the way these surgeries have been described are via an open technique. So this involves bigger incisions and specifically in chest surgery it involves spreading the ribs in order to allow our instruments and our hands to get inside the chest and do the surgery. As modern techniques started to grow, more laparoscopy or what we call thoracoscopy was developed where the surgeon puts a little light and camera inside of the chest to visualize the chest cavity and then uses their instruments through little incisions. The disadvantage with those procedures is that the surgeon is not able to get the same movements that they could with his or her hands. Robotic technology has added the ability to not only get access to the body cavity with smaller incisions and the video camera, but it allows the articulation for the surgeon to move their instruments to mimic their hands and fingers in ways that they probably weren’t able to do before.
So now the types of procedures that you do are minimally invasive procedures for these conditions and for these major surgeries. Talk to us about specialized equipment I assume, and training. How does it make your job a little easier?
Dr. Sancheti: Sure. You do need specialized equipment for robotic surgery. Number one, you need a robot which is a very complex specialized piece of equipment. And you need staff that is adept in working with the robot in your operating room. You do need specialized training as well in order to understand how to use the instrument, how to facilitate it to help you do the things that you are asking of it to do during the operation. At all times you are controlling the robot as a surgeon but there are little nuances that you have to learn through your training and proctoring by expert surgeons in order to get yourself up to the level where you’re able to do it.
The patient we’re going to be meeting soon, you did an esophagectomy on that patient. Tell us what was wrong, why this needed to be done and how this procedure essentially was better for the patient.
Dr. Sancheti: This patient did have esophageal cancer and part of the treatment for esophageal cancer is the combination of chemotherapy, radiation therapy and surgery. The surgery is extensive and complex. It involves disconnection of the esophagus and the stomach from its various connections and removing the esophagus and part of the stomach. Then, the remaining stomach is formed into a tube and used as a new esophagus so the patient can eat normally. Historically and still currently in many areas this is done with an open procedure. Usually a large incision on the abdomen and then one large incision on the chest as well. For this patient, we perfomed the surgery robotically by using multiple small incisions on the belly and a smaller incision on the chest in order to do the surgery exactly the same way we would have done it in open manner but allowing him to recover much easier.
So you can remove the tumor that way?
Dr. Sancheti: We can. The tumor is removed the same way as with the larger incision. It’s actually placed in a specialized bag and then removed from the chest cavity.
How does that affect the recovery, how long do they have to stay in the hospital and how soon can you start feeling better and go back to work and doing the things you want to do?
Dr. Sancheti: These patients stay in the hospital somewhere between five to seven days just based on the fact of the complexity of the surgery. But in terms of recovery and in terms of the ability to get out of bed and move around and do their normal functions and get back to their normal life, that’s much quicker. This is due to the fact that the pain and the fatigue that encompasses a surgery of this extent is much less using smaller incisions and the robotic technology. This patient was up and about and back to his normal life a few weeks after a big operation.
How rewarding is it for you to be able to offer something like this to patients with very serious illnesses?
Dr. Sancheti: As a cancer surgeon, the number one thing is to maintain my ability to hopefully cure this patient of cancer. But being able to do it in a way where it does not put too much hindrance on their lifestyle and their activities and the things that they love to do whether that be work or play and allowing them to get back to that normal lifestyle as soon as possible is really the best reward for us as thoracic surgeons.
So this patient is doing well?
Dr. Sancheti: Doing well. And it seems like that the cancer is pretty well treated at this point too.
Is there anyone who is not a good candidate for this type of procedure?
Dr. Sancheti: Every patient is looked at differently based on the anatomy of their tumor and on their own personal anatomy of their internal organs. If the patient is able to have a surgical procedure, at least at our institution, the first thing that we think about is doing it minimally invasively, hopefully with robotic means. If the patient is not a candidate for that kind of procedure we’re just as well trained in doing an open procedure and we would offer that.
Are the risks of surgery lower with this?
Dr. Sancheti: There’s no data to suggest that the risks are any lower but the most important thing is that it has been shown that the risks are the same. So we’re not doing a riskier procedure trying to do a minimally invasive operation. Now comparing minimally invasive to open procedures in terms of how long they stay in the hospital and complications that are related to pain and recovery, a minimally invasive operation definitely has its advantages.
Do we know how many people require thoracic surgery for cancer a year?
Dr. Sancheti: I can’t tell you an exact number of how many thoracic surgeries are done in a year. I do know that lung cancer is the number one cancer for men and women in this country and if you combine that with esophageal cancer and mesothelioma and thymic cancer and all the other organs that are in the chest that could have cancer in them, that’s a staggering number of people that could undergo treatment for them.
So if you could provide a minimally invasive surgical technique you’re really giving these patients a better chance.
Dr. Sancheti: Absolutely. You’re giving a good chance of curing removing the cancer but also giving them a better chance of recovering from a major operation.
Is there anything else you want to add?
Dr. Sancheti: I don’t think so.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Marybeth.spence@emoryhealthcare.org
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