Suspicious lesions or nodules should be biopsied to rule out cancer, which is tricky when lesions or nodules are in the lungs.
That’s now changing.
Several months ago, surgeons at AMITA Health Saint Joseph Medical Center Joliet began using a new Ion robotic-assisted bronchoscopy system that uses a shape-sensing technology more accurate than older methods and is like a “GPS for the lungs,” said Timothy Nelson, AMITA Health’s system director for communications and media relations
Dr. Wissam Raad, a thoracic and cardiac surgeon at AMITA Health, said older methods provide a definitive answer on lesions only 50% to 53% of the time. The percentage jumps to 90% with this new technology because of the “localizing tips of the robot,” he added.
“That’s because so much depends on the location of the lesion,” Raad said. “Some areas are very hard to reach through the airway channel. With this new robotic bronchoscope, we are able to reach almost every corner of the lung.”
During the procedure, the surgeon inserts a flexible catheter through the patient’s endotracheal tube and then steers the catheter through the airway by following a pre-mapped virtual path from the patient’s CT scan, which leads to the nodule. Fiber optic sensors help the surgeon determine the precise tissue sample to take.
How it compares with older methods
Raad said the entire procedure takes about an hour, although it takes only 15 minutes to find and biopsy the target. The system reaches lesions as small as 4 to 6 millimeters, Raad said.
“With the older techniques, it had to be as big as 1 centimeter to be able to reach it and get an answer,” Raad said.
Before this new robotic bronchoscope, patients had only two options. The first was to wait – and watch.
“This is a very stressful option for patients,” Raad said. “No one wants to wait and watch cancer growing inside.”
The second option was surgery.
“The downside of the surgical option is that it’s an invasive procedure,” Raad. “And there is a chance that we have operated on a benign lesion. The operation could have been avoided if we knew this is not a cancer.”
The Mayo Clinic said another option is needle biopsy. A doctor uses an X-ray or CT scan to guide a needle through the chest and into the lung to collect samples. A needle biopsy also has a 90% success rate, but it comes with a risk – as high as 15% - of a pneumothorax, Mayo Clinic reported in 2019.
Raad said the system came on the market 18 months ago. The system is therapeutic, as well as diagnostic, he said. Because if the biopsy shows cancer, the surgeon may – with the patient’s consent – immediately perform surgery to remove the lesion, thus exposing the patient just once to the risks of anesthesia.
The system also can help locate the very tiny lesions during sugery by injecting a colored dye, Raad said.
“I can see exactly where it’s at, how much margins we need to take to safely remove the cancer and with more precision,” Raad said. “And it will shorten the time of the procedure because it makes it easier to find the target.”
Cancer-free, quick recovery
Belinda Hernandez, 62, of Plainfield underwent the procedure in August. In January 2021, a liver scan found a suspicious lesion on her right lung. The lesion turned out to be lung cancer, but Hernandez took her time finding the right surgeon to remove it.
“The other surgeons wanted to open me up,” Hernandez said.
Hernandez appreciated Raad’s detailed explanations.
“He showed me a diagram of my lungs and how the procedure is done,” Hernandez said. “I was very, very comfortable with him.”
Hernandez spent one night in St. Joe’s intensive care unit and went home the next day. Hernandez said she was back to work in two weeks and recovered by October. A chest X-ray in December showed no signs of cancer. She’ll have a CT scan in March and periodic follow-ups with Raad.
“Who knows how long I had it [lung cancer]? I had no symptoms, no shortness of breath,” Hernandez said. “It is very strange. I’m pretty blessed. It could have been worse.”