Thoracic Surgery

At Lahey Hospital & Medical Center we understand that lung cancer can be a frightening diagnosis. But at Lahey, treatments for lung cancer are better than ever and survival rates continue to increase.

Lahey is at the forefront of robotic lung cancer surgery including robotic lobectomy, which has been shown to be an effective treatment for early-stage lung cancer.

Most, but not all, patients who develop lung cancer have smoked cigarettes at some point in their life. Heavy tobacco use, whether in the past or currently, can place patients at significantly greater risk. Early detection of lung cancer, as with many cancers, is key to improving survivals rates from this dread disease. Lahey is home to one of the largest lung cancer screening programs in the nation. The thoracic specialists at Lahey have substantial experience and expertise in treating lung cancer. Our experience and team approach allow us to provide patients with lung cancer the very best possible outcomes.

Treating Lung Cancer

Surgical resection for lung cancer may involve the removal of a small portion of the lung, a lobe of the lung, or occasionally an entire lung to achieve complete removal of the cancer and ensure normal breathing after surgery.

At Lahey Hospital and Medical Center, we discuss and plan each lung cancer patient’s treatment in our Multidisciplinary Thoracic Oncology Conference and Clinic. We also provide this same expertise for our patients seeking care at Beverly and Winchester Hospitals. Specialists from each of the lung cancer related fields gather to discuss each specific patient’s problem. Our outcomes are excellent due to advances in our ability to diagnose and treat lung cancer using individualized plans for each patient.

VATS Lobectomy

Lahey thoracic surgeons are skilled in a type of minimally invasive lung cancer surgery called VATS lobectomy.

A traditional lobectomy (removal of a lobe of the lung), requires a large incision in the chest wall and spreading the ribs to allow access to the lung. Video-assisted thoracoscopic (VATS) lobectomy, on the other hand, is performed through small incisions and without spreading or injury to the ribs.

Spreading the ribs is not required because the thoracic surgeon uses specially designed instruments and a thin camera that fit between the ribs. Advantages to the patient include less postoperative discomfort in the chest wall, shorter stays in the hospital and, typically, a more rapid recovery of lung function.

Lahey’s Thoracic Oncology Center

The Thoracic Oncology Center at Lahey Hospital & Medical Center’s Sophia Gordon Cancer Center offers comprehensive diagnostic and treatment services for all chest cancers, including lung cancer. A team approach with specialists from radiation oncology, medical oncology, thoracic surgery, interventional pulmonary medicine, radiology and pathology provides the best care for patients.

Our Center specializes in treating chest cancers with the most advanced medical and interventional approaches, supported by therapeutic advancements and state-of-the-art technologies.

Lung cancer conditions treated at the Thoracic Oncology Center include:

• Cancerous tumors in the lungs and airways
• Cancer that originated elsewhere and has spread to the chest (lung metastases)
• Pleural effusions (when cancer causes a buildup of fluid around the lungs)
• Thymoma (a tumor in the center of the chest)
• Mesothelioma (cancer of the tissue that lines the lungs, heart and chest wall)

The thoracic surgeons at Lahey Hospital & Medical Center are experts in treating disorders affecting the esophagus (the tube that runs from the throat to the stomach). Many procedures that in the past required open surgery with large incisions can now be performed with minimally invasive techniques. This can result in less pain, a faster recovery and a shorter hospital stay.

Swallowing Difficulties (Achalasia and esophageal narrowing)

Achalasia is a condition in which the nerves of the esophagus become damaged. It can cause chest pain, difficulty swallowing, heartburn and other symptoms.

Lahey’s thoracic surgeons treat achalasia with minimally invasive laparoscopic techniques, in which special thin instruments and a miniature lighted camera are inserted through tiny incisions. The camera sends images to a video screen, which the surgeons use to guide their progress. This state-of-the-art procedure, called laparoscopic Heller myotomy, produces excellent patient outcomes.

In certain situations, the surgeons at Lahey can treat achalasia using a cutting-edge completely “incision-less” procedure that is performed endoscopically (using a thin camera placed down the throat). This procedure called POEM (Per-Oral Endoscopic Myotomy) produces little to no pain, rapid recovery, and excellent outcomes for patents with achalasia.

The esophageal team at Lahey has a variety of advanced techniques for treating esophageal narrowing, also known as “stricture” or “stenosis”. Esophageal narrowing can be caused from chronic acid reflux, injury, or infection. The thoracic surgeons at Lahey use esophageal endoscopy with dilation (gentle stretching procedure), stenting, and in certain circumstances, surgery to open the area of narrowing and improve a patient’s ability to swallow. Oftentimes, these procedures are performed as “Day Surgery” and the patient can go home the same day as the procedure.

GERD & Hiatal Hernia

In people with gastroesophageal reflux disease (GERD), stomach acid moves upward into the esophagus and causes heartburn. Symptoms of heartburn sometimes lead to long-term use of anti-acid medications. Unfortunately these medications often become ineffective with prolonged use, are costly, and over time, this acid can damage the tissues of the esophagus and lead to cancer.

GERD is often caused by hiatal or paraesophageal hernia. In these conditions the stomach, and lower part of the esophagus, slip from the belly into the chest. This can create pain and acid reflux.

At Lahey, our thoracic surgeons use minimally invasive laparoscopic techniques to repair hiatal hernias and eliminate GERD. In this procedure, the surgeon uses tiny incisions to introduce cameras and small instruments laparoscopically to reposition the esophagus and stomach in the proper place and create a valve to stop acid reflux. Lahey thoracic surgeons also use advanced robotic surgery to treat these esophageal conditions.

Barrett’s Esophagus & Esophageal Cancer

At Lahey Hospital & Medical Center a multidisciplinary team of gastroenterologists and thoracic surgeons have extensive expertise in caring for patients with esophageal cancer and the pre-cancerous Barrett’s esophagus.

Our doctors use high-definition endoscopy (a lighted scope inserted down the throat while the patient is sedated) to examine the esophagus. If precancerous or cancerous tissue is found, it can often be removed at the same time, so patients do not have to go through any additional procedures.

If more extensive esophageal cancer is found, Lahey’s thoracic surgeons can treat it with an advanced procedure called esophagectomy. In this procedure, often performed with minimally invasive or robotic techniques, our surgeons remove all or part of the esophagus and then rebuild it from part of the stomach or intestine.

Minimally invasive esophagectomy uses a thin high-definition camera and small instruments to remove the esophageal cancer without requiring large and debilitating incisions. Lahey’s thoracic surgeons perform a large number of these esophagectomy procedures, and our experience has produced excellent outcomes for our patients.

Robotic Lobectomy

Surgeons at Lahey Hospital & Medical Center are exceptionally skilled at performing robotic lobectomy procedures, shown to be an effective treatment for early-stage lung cancer. Lahey is at the forefront of robotic lung cancer surgery.

Lobectomy is the surgical removal of one of the lobes of the lung, most often to treat cancer. By performing more robotic lobectomies than other hospitals in the Greater Boston area, Lahey surgeons have built expertise and proficiency – which can lead to greater surgical success and a faster recovery for patients.

Lahey’s acquisition in 2016 of two state-of-the-art daVinci Xi Robots opened new opportunities for patients with lung cancer. The new Xi Robots have an optimized design for performing thoracic surgery, giving surgeons better range of motion, better visibility, and the ability to perform specialized robotic lobectomy procedures through incisions that are smaller than ever before.

While Lahey is committed to offering the very latest treatments for lung cancer, we also are committed to prevention with our Tobacco Treatment Program and early detection with our Lung Cancer Screening Program, one of the largest in the nation.

How Robotic Lobectomy is Performed

Robotic thoracic surgery is performed in our special Robotic Surgery suite while the patient is asleep under general anesthesia. The surgeon makes four small incisions on the patient’s side and inserts special surgical instruments and a scope with a tiny video camera at the end. The instruments are connected to the arms of the daVinci Robot.

The Robot cannot move by itself. The surgeon sits at a nearby console and controls all of the Robot’s movements while watching the progress on a three-dimensional video monitor. Because the daVinci Xi Robot has “wristed” instruments that move as the surgeon moves his or her fingers, hands, and wrists, the surgeon has excellent dexterity, precision, and control.

The surgeon removes the affected lobe of the lung and nearby lymph nodes, and removes them through one of the incisions. The surgical instruments are then removed and the incisions are closed with absorbable sutures.

How Robotic Lobectomy Compares to Other Procedures

For many years, an operation for lung cancer involved open surgery, which required a large incision and spreading of the ribs to allow access to the lung.

Then a newer procedure was introduced called VATS lobectomy, a type of minimally invasive lung cancer surgery. Performed through small incisions without the need to spread the ribs, VATS lobectomy offered less pain, shorter hospitals stays, and a faster recovery.

With VATS, the instruments inserted through the incisions are rigid without the same dexterity and the images projected by the camera used for the procedure are only two-dimensional instead of three dimensional.

Lahey surgeons have found that the daVinci Xi Robot has distinct advantages over VATS in performing lobectomies including surgical instruments that are more precise with a wider range of motion and better visibility with three dimensional imaging.

Benefits of Robotic Lobectomy

Among the benefits of robotic lobectomy at Lahey are:

• Smaller incisions. This means patients can recover more quickly and get back to their daily activities sooner.
• Less pain compared to standard incisions. The chest wall is sensitive and surgery can aggravate the nerves within it, but robotic procedures can be done with smaller incisions, in the lower part of the chest where the space between the ribs is greater.
• Quicker return home. Although everyone’s recovery is different, because of the expertise of our surgeons and the use of the Xi Robots, some Lahey patients have gone home in as little as two days after surgery.
• Better ability to determine if cancer has spread. Robotic lobectomy allows for more careful and thorough dissection of the lymph nodes, where lung cancer might be hiding. Knowing if cancer is present in the lymph nodes helps determine the stage of the cancer and whether additional therapy is warranted. If lymph nodes are involved additional chemotherapy can significantly improve survival so removal of lymph node and accuracy of staging is critically important. The Xi Robot facilitates a meticulous and thorough dissection of each patient’s lymph nodes.

Why Lahey for Robotic Lobectomy?

There are a number of reasons why patients and referring physicians choose Lahey for robotic lung surgery:

• Lahey surgeons have experience performing robotic lobectomy procedures, which require specialized expertise. As with virtually any type of surgery, the more clinicians perform a certain procedure, the better the outcomes.
• Lahey has the very latest Xi Robot technology to perform robotic lobectomies, which means patients benefit from the most recent medical innovation.
• Lahey is known for our “team approach” to care. Our hospital-based surgeons work together, so patients benefit from a collaborative environment and the expertise of multiple providers.
• Lahey has a dedicated thoracic robotic surgery nursing team that has become skilled at important aspects of robotic procedures, particularly the specialized instrumentation used by the surgeons. This allows for more seamless, coordinated care for patients.
• Lahey has a dedicated Nursing and Physician Assistant team that routinely cares for our thoracic surgical patients as we feel that postoperative care is just as important as intraoperative care.

Other Thoracic Robotic Procedures at Lahey

Lahey’s expertise in thoracic robotic surgery extends beyond lung cancer treatment. Other conditions that we treat with thoracic robotic surgery include:

• Benign and malignant esophageal tumors
• Hiatal hernias and gastroesophageal reflux disease
• Benign and malignant mediastinal tumors including thymomas
• Paralyzed hemidiaphragm (by placating and flattening the diaphragm to improve breathing)
• Myasthenia gravis – a rare disorder resulting muscular weakness