Director of Robotic Thoracic Surgery at Emory Saint Joseph’s Hospital, Dr. Manu Sancheti, talks about a new ion robotic surgery to detect lung cancer quicker.
Interview conducted by Ivanhoe Broadcast News in 2023.
What is the CIOS Spin and how does it diagnose lung cancer early?
SANCHETI: So essentially the CIOS Spin has been as part of an entire package of technology that allows us to find lung cancers earlier and then potentially detect them and biopsy them earlier with where my role comes into potentially treating them earlier with surgery. So the CIOS Spin is a CT scanner essentially, but it’s a portable CT scanner that we can bring into the operating room, that we can bring into the endoscopy suite. And during our procedures when we’re passing the needles and passing the probes to get to the nodules or get to the lung cancers, we can take a CT scan right then and we can see exactly to make sure that we’re putting that needle exactly where it belongs in order to get a diagnosis.
Early detection to survival is the key. Talk to me about that and how this helps that.
SANCHETI: So in most cancers, early detection is going to be the biggest prognostic factor when it comes to your long-term survival. So if you find a cancer early, you treat it early, you’re going to do better overall. With lung cancer specifically, it’s very difficult to find cancers early. Only about 20 to 30% are found early. And part of that is it’s difficult to not only identify them, but it’s difficult to biopsy them when they’re very very small. So with the advent of the robotic bronchoscopic ion technology with the CIOS Spin, we’re able to get to these nodules a little bit sooner than before and biopsy them, prove them to be lung cancers, and then potentially resect them or remove them with robotic technology as well.
How was lung cancer traditionally diagnosed and how does that relate to this technology now?
SANCHETI: Well, the traditional way or the old school way of diagnosing lung cancer is really through a CT scan. And if we saw a small nodule that we’re concerned about, but we knew it was too small for us to really get to for a biopsy. Our options are just to continue follow it with CT scans every 3-6 months, essentially, waiting to see if it grew so that it would be big enough for us to either remove or biopsy. Another option would be needle biopsy from the outside through the ribs. Again, that can be difficult when you have a small nodule and you can imagine the lungs are moving while they’re trying to place that needle. So robotic ion bronchoscopy allows us to get to the nodules a little bit sooner, almost with like a computerized GPS to know exactly where we’re going and get the biopsy a little bit sooner.
Is it, generally, the same procedure once this new technology is used?
SANCHETI: Right. So once the ion bronchoscopic procedure diagnosis the lung cancer, then it gets down to standard of care essentially for early-stage lung cancer and the treatment is surgery. Well, we add the potential of doing is also robotic minimally invasive surgery for these lung cancers and we also have the potential of doing them at the same time. So the patient goes to sleep with a nodule of unknown origin or unknown diagnosis. We bring the ion into the operating room, we biopsy it, we diagnose it. If it does come as cancer, while they’re still asleep, we go ahead and do the robotic surgery and remove the cancer. So in one big anesthesia event, we get everything taken care of.
How exactly does the CIO Spin work and what does it show through your eyes?
SANCHETI: The CIOS Spin really just provides even more confirmation from an imaging perspective exactly where the needle and the bronchoscopic catheter is. And so just like a CT scan that you would get for anything else, it’s a CT scan that we can do while the patient’s asleep on the operating room table or the endoscopy suite. Again, to confirm exactly where our probes and our needles are going and make sure we’re in the right spot.
What advantages does the ion robot give you?
SANCHETI: Well, I think with our experience with the ion robot, we’ve done a lot of procedures now and looking back, it allows more accurate detection and diagnosis of lung cancers, especially the smaller ones. It allows us to get to those patients a little bit sooner and treat their lung cancers if they have them. And the technology is only growing. So the potential for doing more and more for these nodules for patients with lung cancers is only going to go up from here.
What type of patient is most beneficial from this?
SANCHETI: Every patient. I think the main patient that’s going to benefit are those patients that you’re concerned about a lung cancer, you see lung nodules in there, but they’re small nodules. You’re not 100% sure, and previous technologies would not allow us to get to those nodules. So the patients that are going to benefit the most are those early nodules or small nodules that we can get to a little bit sooner. But honestly, I think the trend, especially at our institution, is moving to almost every biopsy of a lung nodule or a concerning lung cancer for any patient is going down the ion robotic bronchoscopic.
How has this technology made it more accurate for you?
SANCHETI: It’s much more accurate from a diagnostic perspective, primarily because you’re integrating the computerized, like I said, GPS. You’re using the robotic maneuverability in terms of driving that endoscope to exactly where you want it. And then you’re following that with the CT scan with the Cios Spin on the table to make sure your catheter and your needle are in the exact right place.
What does it let you do that you couldn’t do before?
SANCHETI: I think the main thing that we couldn’t do before is do those same anesthesia. That’s where we diagnose somebody and treat them all in one anesthesia. That was not possible with the previous biopsy techniques. So getting to those patients a little bit sooner and treating them sooner, maybe on the same day is an exciting potential that we’ve never been able to do before.
Are there any risks to this?
SANCHETI: There’s risks to any procedure, in terms of, especially in an invasive procedure where you’re putting catheters and needles down. Our data shows that the risk overall is very low of a infection, bleeding, collapsed lung, things of that sort.
And we’ve talked about this before but, you mentioned every patient, but are there any specific patients, it’s on high-risk patients, low-risk patient. Give me an idea on specific type of patients this would be best for or maybe not best for.
SANCHETI: I think the best patients are going to be those high-risk patients for lung cancer. So the patients that we want to really identify those that are getting their CT lung cancer screening, they had a history of smoking or still currently smoking, they should be getting annual CT scans, and if they identify a lung nodule on one of those, then we can biopsy it earlier and treat it. Now, I want to make the caveat that all lung cancers not ingest in smokers. And so if a patient, for whatever reason gets a CT scan and even if they’re not a smoker and they see a lung nodule, that should be followed, that should be investigated. Just because you’re not a smoker doesn’t mean you can’t have lung cancer.
What are ground-glass opacities?
SANCHETI: So ground-glass opacities are just like clouds or hazy areas in the lung that can be many things. But one of the things that we worry about the most is that it could be the earliest stages of a lung cancer before it almost forms into like a tumor or a ball. Previously, whenever we saw those, they are difficult to diagnose. You imagine putting a needle into a cloud, it’s just going to poof. They’re difficult to diagnose, they’re difficult to find because you can’t see them in the lungs. So if you had to take them out with surgery, they’re difficult to find. And so a lot of times previously, we would just watch them with CT scans until they essentially got solid and we could deal with it. Now we have the ability to not only accurately biopsy with the ion robotic bronchoscopy, but we can also place some fluorescent dye next to those nodules. And then using the robotic da Vinci surgical platform, which is what I use for surgery we have a special camera on that, that lets us see that fluorescent dye. So even though I cannot see that cloud, I can see the fluorescent dye and I know that at that point I need to cut out the fluorescent dye and that would get me the spot. And oftentimes, those end up being very early-stage lung cancers before they turn into nodules and such. So overall providing a good prognostic.
If this wasn’t available what would you do in your practice?
SANCHETI: I think we would continue like we were in terms of getting CT scans, following nodules until they grow and we can either remove them or biopsying with the previous technology safer.
How else has this changed the game, for you as a doctor?
SANCHETI: I think personally it’s very exciting. Number one, it’s making us very busy. And so we’re finding a lot of lung cancers and we’re taking them out much more than we were before and that’s great. I think the biggest factor is that we have the potential when patients find lung nodules or we find lung nodules on patients. We have the ability to say, you know what, we can get to this. We can give you an answer and we potentially can take this out sooner than we could before. So it’s very exciting technology.
Is there anything that you would like to add?
SANCHETI: So I think an important factor of the ion technology is the fact that it allows early detection and early treatment. And so the previous technology really did not allow us to get to those patients early and get them treated very quickly. And so something where a process of multiple appointments to different doctors and different procedures could take several weeks. Now we have the ability to biopsy the patient and potentially treat them if it is a cancer under the same anesthesia. So we can get something done literally within the same day. So somebody comes in with a lung nodule. We biopsy it. If it is cancer, we take it out right there with robotic technology as well. And then something that used to take several weeks is now compressed down to two or three days.
Technology is really making a change in everybody’s lives from AI to what you’re doing. So, talk to me about that as a final thought on how the industry is moving forward in your space with robots and technology.
SANCHETI: Well, as the director of robotic thoracic surgery here at Emory, I’m more than excited about the potential of integrating technology into health care. I think robotics as a whole, has allowed us to be- allowed it to be an adjunct to the procedure lists, the surgeons in terms of almost extending our hands to allow us to do things through small incisions that we previously we’re not able to do with a lot of dexterity. I think in the future we’re getting even more into augmented visualization and improve visualization to find those cancer cells to improve what we see inside the patients bodies in order to treat them earlier and treat them quicker.
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.
If you would like more information, please contact:
Josh Brown
Joshua.g.brown@emoryhealthcare.org
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