Breathe Easier

Robotic Lung Surgery Offers Hope to Formerly Inoperable Patients

Cookeville Regional is proud to offer patients robot-assisted thoracic surgery using the da Vinci® Surgical System.

“We started two and a half years ago doing lung resection (removal) with the da Vinci system,” said Dr. Timothy Powell, M.D., of Cardiac, Thoracic and Vascular Surgery

Associates, whose physicians perform these surgeries at Cookeville Regional. “Prior to that, I was still doing video-assisted thoracoscopic surgery (VATS), a minimally invasive procedure, but the da Vinci system gives you 3-D, high-definition visualization, and the instruments have a wrist function that allows you to be more precise and get better angles and a lot more versatility than the VATS procedure.”

The surgery for removing lung cancer has traditionally been thoracotomy, in which the surgeon makes a 6- to 8-inch incision and spreads the ribs apart to make way for hands and instruments. Next came the VATS procedure, which requires three to four small incisions — one medium-sized incision and two to three other small incisions, without spreading the ribs.

The latest advancement, robotic surgery using the da Vinci system, only requires five small incisions — four for the robotic arms and camera and one for an assistant to work through. The largest incision is 2.5 to 3 centimeters long, and the rest are around a centimeter long.

The operation takes about three hours to perform. Patients generally spend a night in the intensive care unit and then move to the step-down unit, and they generally go home in three to seven days. Most patients can return to normal activity within a week or two, compared with two to three months for the traditional surgery.

“Patients who have this surgery benefit from a shorter recovery period and less chronic pain,” said Dr. Powell. “There's still a place for the open surgery for sure, but for patients who are good candidates, this is a great option.”

Almost any patient with a resectable (removable) lung tumor — the type most often found during stage 1 or stage 2 cancer — is a candidate for the da Vinci surgery as long as they haven’t had a previous surgery on that lung.

Dr. Powell says he uses the da Vinci now for approximately 90 percent of the lung tumors he removes, noting that this type of surgery provides hope for patients who might not have been able to endure the traditional surgery.

“The majority of our patients are or have been smokers, as most lung cancer is related to smoking,” he said. “They've got emphysema, and it doesn't mean they're not a candidate, but they may be slower to recover. But there's even more benefit for a patient like that who’s a marginal candidate. If you can get them through an operation without a big incision and with less pain, then they're going to do better.”

For more information about da Vinci lung surgery, call Cookeville Regional at (931) 783-2571.



Barbara Welsh • Crossville, Tennessee

Diagnosis: Stage 1 lung cancer

Physician: Dr. Timothy Powell

Treatment: Robotic-assisted lobectomy


Less invasive robotic surgery put her mind at ease

When Barbara Welsh of Crossville visited her pulmonologist to discuss the results of a CT scan for her pleurisy, he informed her that he had also found a spot on her right lung. He monitored it for a year, and in that time, it doubled, so he referred her to Dr. Timothy Powell, a cardiac, vascular and thoracic surgeon at Cookeville Regional. Dr. Powell discovered that the spot was a stage 1 cancerous tumor.

“As bad as pleurisy was, it was a blessing, because I had no lung cancer symptoms at all,” said Barbara, who has never smoked. “That's one of the bad things about lung cancer — often it won't cause symptoms until it's more advanced,” said Dr. Powell. “With people getting more imaging these days, we can find things incidentally and have a better chance of getting them out for a cure.”

And that’s just what he did. Dr. Powell removed the 2-centimeter tumor in December 2012 through four small incisions using the da Vinci® Surgical System. Because the tumor was found early and was completely removed, Welsh was able to avoid radiation and chemotherapy. As of her last CT scan in June, she remains cancer free.

“I went home and did fine. I had very little pain,” said Welsh. “A month after I had this surgery, you'd never know I’d had anything done.”

"Some of our patients who might not be candidates or might be too high-risk for traditional open surgery might be considered for robotic surgery,” said Dr. Powell. “Also, a lot of our patients who are marginal candidates — because they have conditions like emphysema that make it harder for them to recover from surgery — benefit from robotic surgery because of the smaller incisions and decreased pain.”