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Minimally Invasive Thoracic Surgery: Why Is It The Best Option For Patients With Lung Cancer

    Minimally invasive thoracic surgery is the best option for some patients with lung cancer. It means less pain and a quicker recovery than traditional surgery.

    Thoracic surgeon Daniel Raymond, MD, says he uses minimally invasive techniques about 80% to 90% of the time. However, he notes that not all thoracic surgeons have the experience or training to use these approaches.

    Video-Assisted Thoracoscopic Surgery (VATS)

    Video-Assisted Thoracoscopic Surgery (VATS) is a standard minimal access procedure used to perform many different types of surgeries in the chest and lungs. During VATS, surgeons make minor cuts in your chest wall and use unique cameras and surgical tools through these cuts to perform your surgery.

    During this surgery, you are put under anesthesia and given oxygen through a breathing tube. Your doctor may also need to insert other surgical instruments through these cuts.

    Doctors like Armen Parajian can do several things using these instruments and the camera, including removing part of your lung or draining fluid from your lung. You can recover more quickly after a VATS than with the traditional open surgery approach. 

    Endobronchial Catheterization

    Endobronchial Catheterization is a minimally invasive procedure that allows physicians to perform a technique known as transbronchial needle aspiration (TBNA) in which tissue or fluid samples are obtained from the lungs and surrounding lymph nodes without conventional surgery. This procedure can diagnose lung cancer, infections, and inflammatory diseases like sarcoidosis.

    The procedure involves inserting a tube into the bronchi and passing it through a small hole in the chest wall. The tube is then guided by a probe.

    This technique helps obtain samples of the lungs, but it can also be used to remove a tumor or clot from the bronchi. In addition, it can be used to place a mechanical valve in the airway to control airflow.

    Selective catheterization of small vascular branches is relatively simple, especially with the Muller Rotoflector Guide System4. The system has been used for selective arteriography, venography, and duodenal intubation.

    Ion Endoluminal System

    The Ion Endoluminal System is a new robotic platform that allows physicians to conduct minimally invasive biopsies deep within the peripheral lung. It uses an articulating robotic catheter that is only 3.5 mm in diameter and articulates 180 degrees to help navigate through small and tortuous airways.

    The catheter is equipped with shape-sensing technology that measures the whole shape of the device hundreds of times per second, providing precise location and shape information throughout navigation and biopsy. It also features a Flexision biopsy needle that bends with the catheter to pass through tight bends in the airways.

    During the procedure, the clinician navigates the Ion through a pre-planned pathway to reach a virtual target nodule on the CBCT. The biopsy is performed using forceps or a flexible needle through the 2 mm working channel of the catheter.

    The Ion Endoluminal System has received FDA approval for use with the Siemens Healthineers Cios Spin mobile cone-beam CT (CBCT) imaging technology. This integration enables physicians to gain confidence in refining Ion’s catheter positioning and helps improve biopsy tool placement.

    Non-Intubated Thoracoscopic Surgery (NITS)

    Non-Intubated Thoracoscopic Surgery (NITS) is a minimally invasive technique that allows the use of regional anesthesia without general anesthesia and intubation. It is used for surgical procedures that would otherwise be contraindicated for standard endotracheal intubation.

    NITS has been characterized by the possibility of achieving a low risk of intraoperative and postoperative complications. The significant benefits of NITS include: a reduction in hospital stay, decreased postoperative pain and paraesthesia, both short and long-term, and lower surgical costs.

    NITS has also been shown to be safe and effective in various high-risk patients. Specifically, this technique has been used to treat the elderly and patients with advanced respiratory disease. Moreover, NITS effectively manages patients with extensive pleural adhesions or large centrally located tumors. Nonetheless, this technique is still relatively new in the thoracic surgery field, and few randomized studies are comparing it to conventional methods.