Lung-sparing Surgery Evolves with Navigational Bronchoscopy and Robotic Surgery at Hackensack University Medical Center

Recently published studies and precision surgical technology supports shift from lobectomies to wedge resection and segmentectomy for early stage lung cancer

December 11, 2024

Advances in navigational bronchoscopy and robotic lung surgery, combined with recent published studies, has shifted lung resection from lobectomies to lung-sparing wedge resections and segmentectomies.

Nabil Rizk, M.D., Chief, Thoracic Surgery, Co-Director, Thoracic Oncology, Hackensack University Medical Center, compares the recent advances in lung-sparing surgery to the evolution of breast cancer surgery—from radical mastectomies to smaller lumpectomies.

These trends towards lung tissue preservation have emerged in recent years after decades of relying on limited clinical study data regarding local recurrence risk, which had previously justified more extensive lung resections. Recent studies have shown no significant difference in outcomes in lobectomy versus segmentectomy or wedge resection for early-stage, node-negative lung cancer, surprising many in the field.

Dr. Rizk explains, “The proportion of lobectomies that we perform for lung cancer is much smaller now compared to wedge resection and segmentectomies. With enhanced visualization and dexterity provided by the surgical robot, complex anatomical segmentectomies are easier to perform than with prior minimally invasive techniques.”

The gradual increase in lung cancer screenings and incidental nodules found during unrelated scans has led to smaller and less solid nodules being investigated. Ion robotic bronchoscopy can be used to localize these lesions in the operating room, allowing lung sparing robotic surgeries to be performed under the same round of anesthesia with only a few minutes added to the case. In addition, Dr. Rizk and his team of thoracic surgeons are evaluating using advanced 3D medical modeling to help determine who may be proper candidates for lung-sparing segmentectomies.

Two decades ago, patients often faced a thoracotomy incision with an open lobectomy, five-day hospital stay, and weeks of recovery. Today, similar nodules can be removed minimally invasively with a wedge resection, allowing patients to go home the same day.

Currently only 5 to 10 percent of eligible patients are screened for lung cancer. Dr. Rizk suggests that if more patients are screened, and if screening shifts from CT scans to blood-based methods, the need for precise lung tissue removal procedures will grow. In the future, immunotherapy and tumor DNA blood screening might eliminate many surgeries altogether. Until then, Dr. Rizk and the thoracic surgeons at Hackensack University Medical Center are prepared to use the latest minimally invasive robotic technology to provide the best evidence-based quality care for lung cancer patients.

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