In 1966 a team of five people boarded a Navy submarine, which was then shrunk to the size of a microbe and injected into a scientist who had an inoperable blood clot in his brain. The team’s mission: to travel to the brain through the bloodstream and destroy the clot with lasers. To the relief of everyone watching the sci-fi film Fantastic Voyage, the tiny lasers did the trick.
Although science hasn’t come quite that far, robotic navigational bronchoscopy is enabling physicians at Roswell Park to take a different kind of fantastic voyage deep into the lungs of their patients to biopsy very small areas that may contain cancer. This makes it possible to diagnose lung cancer earlier and begin treatment sooner, increasing a patient’s chances of survival and avoiding more invasive diagnostic procedures. As one of the first hospitals in the nation and the only center in New York State equipped with the MonarchTM Platform robotic bronchoscopy system, Roswell Park has that capability.
Avoiding Unnecessary Surgery
Today screening programs use CT scans to look for signs of lung cancer in people at high risk of developing the disease. Thanks to improved technology, those scans can detect extremely small nodules and abnormal areas found very deep in the lungs.
But it’s far more complicated to figure out whether or not those spots are actually cancer. Until now, whenever imaging showed suspicious spots that could not be biopsied because they could not be reached with standard bronchoscopy, physicians had to choose one of two options:
- Wait and see whether the spots grew and started behaving like cancer, but that carried the risk of letting the cancer spread, explains Sai Yendamuri, MD, FACS, Chair of Roswell Park’s Department of Thoracic Surgery. “The difference in treatment and outcomes between a one-centimeter nodule and a two-centimeter nodule is significant. Larger cancerous nodules need more-aggressive surgery, are more likely to have metastasized and have poorer outcomes.”
- Perform surgery to do the biopsy, which carried the risk of a collapsed lung and other complications.
The Monarch system means patients can get the diagnosis they need without unnecessary surgery and begin treatment at a stage when treatment is likely to be more effective.
Interventional pulmonologist and thoracic surgeon Nathaniel Ivanick, MD, Department of Thoracic Surgery at Roswell Park, says the new technology will be used mainly for lung nodules that are considered intermediate risk: “We want to get an answer to what they represent, but we’re not believing them to be so high risk that we need to jump in immediately to surgery.”
Patricia, age 78, came to Roswell Park from Pennsylvania to undergo a bronchoscopy with the Monarch system. She had previously received two cancer diagnoses — breast and uterine — and had developed a lung condition called ground glass opacity, which is strongly associated with cancer. As a retired Licensed Practical Nurse and cancer survivor, she understands the importance of regular cancer screenings and gets her mammograms on schedule “to keep ahead of things.”
Although she had no symptoms of lung cancer, imaging showed a suspicious area at the edge of her lung. When it grew and appeared denser, she knew she had to take action. “It won’t go away on its own,” she says. “I knew we had to get in there to see what was going on.”
She had no hesitation about the procedure and gives the experience a thumbs-up. “I thought it was great!” The biopsy obtained with the Monarch system confirmed that she has lung cancer, but there’s good news: It’s stage 1 and can be treated with radiation.
How Does Robotic Navigational Bronchoscopy Work?
The Monarch system combines the latest advancements in robotics, computer navigation and 3D imaging, providing superior vision, control and precision. As the bronchoscope enters the patient’s airway, the interventional pulmonologist views a split screen that displays several images, including one that’s very much like an interactive You Are Here map. It shows the area targeted for biopsy, the real-time location of the bronchoscope and the route the interventional pulmonologist needs to take to guide the bronchoscope to the target.
In another window, a magnified 3D image shows what the camera is seeing as it travels through the lungs and its passageways. If the camera shows any areas of concern along the way, those spots can be biopsied during the procedure.
“Greatest Safety and Accuracy”
“I have a number of tools at my disposal,” explains Dr. Ivanick. “Robotic navigational bronchoscopy brings all of those tools together and allows me to take information from all of them to choose where I’m going to take the biopsy with the greatest accuracy, the greatest safety, and with real-time visualization so I can actually see the tumor — if that is what it is — as I’m taking the biopsy.”
Dr. Yendamuri says that by reaching spots that previously would have been out of reach, Roswell Park’s Lung Cancer team can confirm a diagnosis of lung cancer earlier and “perform a less-aggressive surgery and preserve more of the lung, with far less risk than removing an entire lobe or lung.”
Dr. Ivanick adds that the new system “will give patients the most options possible for what they can do to treat their cancer. Performing a biopsy that removes less lung tissue will enable patients to “go home quicker and have a healthier life.”
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