Less Invasive Surgery for Lung Cancer Presented

Procedure uses small incisions and a miniature video camera to reduce the risk of complications from surgery for lung cancer.

A large international clinical study presented at the 99th Annual Meeting of the American Association for Thoracic Surgery demonstrated that thoracoscopic lobectomy, or video-assisted thoracoscopic surgery (VATS), combined with pulmonary artery sealing via an ultrasonic energy device reduced the risk of post-operative bleeding, complications, and pain from surgery for lung cancer.

The treatment is different than surgery with thoracotomy, which involves making a 25 cm incision in the patient’s chest and cutting the ribs, whereas a VATS procedure requires small incisions. A miniature video camera is inserted through one of the incisions. In both types of surgical interventions, there is a risk of bleeding due to the branches of the pulmonary artery, which are very thin, fragile, and are attached directly to the heart.

Currently, only 15% of lobectomies around the world are performed by VATS, mainly because of the actual risks of major bleeding or surgeons' perceptions of these risks.

After 5 years of preclinical research at the University of Montreal Hospital Research Centre, which included trials conducted on animals, as well as phase 1 and 2 clinical trials that showed the safety of the surgical intervention, investigators recently completed a large international phase 2 clinical trial launched in 2016.

The clinical trial was able to evaluate the efficacy of this new technique on 150 patients in 8 hospitals across Canada, the United States, and the United Kingdom. One hundred and thirty-nine of them underwent a lobectomy, while the remaining 11 underwent a segmentectomy, or the removal of a small part of the lung.

According to the press release, a total of 424 pulmonary artery branches were sealed during the study: 181 using surgical staplers, 4 with endoscopic clips, and 239 using the Harmonic Ace +7 Shears. With a 3-millimetre jaw at its tip, this high-tech "pistol" allows a surgeon to seal blood vessels by delivering ultrasonic energy.

"I truly hope that the results of our clinical trial will reassure surgeons about the technical feasibility and safety of this operation and will encourage them to adopt it. A large number of patients could benefit from it and would be on their feet faster, with less pain," said study investigator Dr. Moishe Liberman.