Thoracic Surgery Update

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by the Sydell and Arnold Miller Family, Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Sudish Murthy, MD, PhD:

So, I'm here to talk about the robotics. And robotics for us is about a decade old in Thoracic, about two decades old in Cardiac. We started in about 2012. And those of you who remember, we had one room, one day, one per month. And I was a fair bit into my practice at that time, and I was charged with trying to get this thing online. And so, we moved forward, and by 2016, we had one room per week, which was fine, and I was fairly further on. We added another junior faculty there. And then, by 2019, we had Dr. Svensson and Dr. Gillinov get us a robot for our own room. And then we were able to really expand the program, which was terrific.

So, these are the volumes. We are one of the highest volume thoracic robotic users in the country, where we're somewhere between 250 and 300 cases every year. We've done over a thousand cases in the last year, which is very close to just a little under five years, what we've done in cardiac, in the valves over the 20 years. So, we do everything with the robot. We do lobectomy. We had a decrease only because we lost one of our high-volume robotic lobe surgeons, but we do esophagectomies. And my team is waiting for today because we're going to be starting an esophagectomy on the robot fairly late. And so, it's kudos to them for helping us through these things.

The benign esophagus you saw. And we saw the mediastinal tumors. And I looked at this data and I thought that there's something wrong. And we had our cracker jack stats staff look back at this. And in fact, this is the actual volume of mediastinal tumors. So, we do essentially everything.

So that's not exactly new. What is new with the robot? Well, I showed you this last year where there's a fair bit of risk for the surgeon when you sit into that console. You get smack and crunch and bang. So, I showed you that last year. Well, this is something that we have found this year. This is the console, and this is the soundtrack that is coming from room 70. While I'm doing a lobectomy, this is what I'm hearing. So, all of us now in room 69 are speaking much louder. We're not yelling. It's that we're preconditioned with this. So, there you go.

Now, what else is new? And this is what we're really proud of. This is a standard esophageal cancer here, and on the robot, it's the same operation. There's the stomach coming up into the chest, but we have new tools on the robot that we use to try to make our operations even safer. This is a vascular imaging dye that we use, and we're looking at that gastric conduit to see that it is perfused. This is ICG, and this is now something we brought into the program in the last eight to 10 months, and that gives us some comfort that we have good blood supply to the very tip of that stomach that we're going to hook into that little anvil up higher.

So, this is the anvil going in and coming out with the staple being provided. And now we got to close that area. We have some bleeding there, so that's always a good sign when you have bleeding at the tip of your conduit. It looks pretty healthy. So, we close that up and there's some bleeding right there. So, we close that up and then we do one more dye study and we see profusion all the way to the tip. So, this makes our operations safer, and we think better for our patients. And as Dr. Raymond brought up, the other place we use these new dyes is on a case like this where you have a fairly indolent but developing lung cancer in the left side. And this is in a place called the superior segment. So instead of sacrificing half of this gentleman's lung, can we just take out that segment of pie that this tumor happens to be in?

And it's pretty hard when you're in an operating room. I'm not here to teach you how to do this operation, that's the windpipe. But now you're trying to figure out where in the lung you need to cut to make sure, one, you get the tumor out, and two, you're following that oncologic segmental principle. So that's the segment. You can see it's a little wider. We've taken all the vascularity out of it, and I think I'm going to cut right there, but it's kind of guesswork. So now we can use these profusion agents to figure out which part of the lung isn't perfused because I devascularized the area that I want to take out. So, let's see what happens here. There. I've injected there. I can't get much clearer than that. You talk about X marks the spot. So now we know exactly the segment of lung we're going to be taking out, and we're just going to mark it so we can see it once we turn the lights back on. This is special firefly imaging. There's the tumor right there. So, it almost comes right up to the fissure of the next segment. So now we can easily take this area of lung out. We know it's completely devascularized and we know that our tumor is inside of it.

These are the new innovations that we're using with the robot. Again, because we're so high volume, we have such a highly functional operating room team with the robot, we're able to do some of these unique things that not many people really think about. So quite frankly, I can't wait to show you what we'll be doing next year on the robot.

And the one thing I always end is I end with the heroes that we operate on, who cheer with us something that's priceless and that we covet, which is their lives. And with that, I'll thank all of you for your tremendous work this year. Thank you.

Announcer:

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