For the first time at UC Davis Health, physicians have performed a single-anesthesia robotic procedure that included both the diagnosis and treatment for lung cancer — all in one surgery.

The procedure, known as robotic-assisted bronchoscopy, reduces a patient’s stress and anxiety by removal of a lung cancer mass at the time of diagnosis.

Interventional pulmonology is one of six specialties in which UC Davis Medical Center offers minimally invasive, robotic-assisted technology. The procedure also is available for gastrointestinal, cardiothoracic, gynecologic oncology, otolaryngology and urologic surgeries.

“Innovations such as the robotic bronchoscopy platform represent patient care at the absolute highest level, from diagnosis to treatment, with a multidisciplinary team approach,” said Bahareh Nejad, director of the Department of Obstetrics and Gynecology’s Division of Robotic Surgery. “As we continue to grow the UC Davis Robotics Program, the institutional support we have received has been instrumental. We are excited to facilitate more growth with robotic surgery to make patient treatment better and more efficient.”

Streamlining patient care

Traditionally, a patient who is diagnosed with a suspicious nodule or mass in a lung is referred to a pulmonologist, who may perform a biopsy to confirm if it is cancerous.

If the lung nodule or mass is confirmed to be cancer, the patient may be referred to a thoracic surgeon who determines if it can be surgically removed. If surgery can be performed, the patient undergoes another procedure on a separate day that requires additional anesthesia. On average, patients may wait up to three months from the time a nodule or mass is first discovered until receiving a diagnosis and treatment.

“Waiting months between a biopsy and a diagnosis can be an emotionally difficult and exhausting experience for patients,” said Chinh Phan, director of the UC Davis Interventional Pulmonology Program. “By utilizing the robotic-assisted bronchoscopy platform, we can help reduce the anxiety and unnecessary waiting times that patients traditionally experience.”

The robotic-assisted bronchoscopy procedure utilizes the Ion endoluminal system developed by Intuitive Surgical Inc. The high-tech platform creates a 3D map of the patient’s lungs using a CT scan. The software then generates the safest and most efficient route through the lung to the nodule or mass. Once the route is determined, an ultrathin and ultra-maneuverable catheter is guided to the site of the lung nodule or mass, where it is marked and biopsied with precision and stability. Lymph nodes also are biopsied during the same procedure, using ultrasound. The samples are then evaluated on-site.

If the lung nodule is determined to be an early-stage cancerous tumor, the surgical team uses the same navigational route to mark the area with dye to prepare for its removal. Then the patient, while still under anesthesia, has a second robotic procedure to remove the lung cancer a short time later.

As an example, the UC Davis Health team identified a roughly half-inch long nodule in the right upper lobe of a patient’s lung, performed a biopsy, identified malignant cells and injected an inert dye for marking, all within 45 minutes. Surgeon Luis Godoy subsequently used the da Vinci Robotic System by Intuitive to safely remove the lung cancer. The patient was discharged and returned home 24 hours after being diagnosed and surgically treated for lung cancer.

Luis Godoy uses the da Vinci Robotic System by Intuitive
Luis Godoy uses the da Vinci Robotic System by Intuitive to remove a lung cancer mass.

“With these two robotic technologies, we now have the ability to diagnose and treat suspected early-stage lung cancer patients in one anesthetic event,” Phan explained. “To put it into perspective, the National Comprehensive Cancer Network guidelines for time from diagnosis to surgical treatment of lung cancer is eight weeks; we have set a new standard for innovative and efficient patient care.”

Shift in preventive screening

Lung cancer is the leading cause of cancer-related death in the United States among men and women, making up almost a quarter of all cancer mortalities. It tends to spread quickly, shows no symptoms unless it is very advanced, and can silently spread to virtually any part of the body. This makes early screening and treatment critically important.

“The most effective method for treating cancer is to catch it early and to start treatment as soon as possible,” Phan explained. “With these new screening guidelines and our robotic-assisted bronchoscopy platform, we are introducing a paradigm shift in lung cancer treatment that will further advance health equity for our community and others.”