Robot surgeon tackles lung cancer in hours

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Full Name: Kannivelu Badrinath
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Robot surgeon tackles lung cancer in hours

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Patients with suspected lung cancer can be diagnosed and cured within six hours using a new robotic biopsy system.
A thin, remote-controlled tube allows surgeons to get deeper into the lungs than earlier technology, and take samples of tiny imperfections picked up by standard scans.

At the moment, patients who have a small potential tumour identified on a CT scan of their lungs will typically be told to “watch and wait” for six months before a second scan to see whether it has grown.

The Ion Endoluminal System consists of a 3.5 millimetre thin tube that goes down the anaesthetised patient’s throat, down which cameras and tools can be threaded.

It is connected via a mechanical arm that ensures stability, which in combination with its size means even the small branches at the very edges of the lung can be targeted.

A computer program takes the patient’s scan and creates a GPS-style map for the surgeon to follow through the lungs to the problem area.

Using a trackball and scroll wheel, they can control the movement of the tube through the airways, watching progress via images from a camera relayed to a screen.

Demonstrating the technology, Sarah Adekola, clinical applications engineer for Intuitive, which developed the system, said: “What the physician will do is always be looking at the live view and just referencing the navigation for where you need to go. It’s like you’re looking at the windscreen when you’re driving and then you’re referencing your GPS to know what turning to take.”

The Ion system is undergoing testing in NHS hospitals, while one London private hospital has this month become the first in Europe to offer it as routine care to patients.

Tom Routledge, consultant thoracic surgeon at London Bridge Hospital, a private HCA Healthcare UK site, predicted that the technology would be in every UK hospital within a few years. As the NHS rolls out lung cancer screening, increasing numbers of people are likely to be told they have abnormalities that need monitoring.

The national screening programme is expected to carry out 992,000 CT scans per year, and studies suggest about 35 per cent of people having a lung CT scan will have one of the imperfections, or nodules, identified.

Routledge said: “We’re telling tens of thousands of people in the UK every year that they might have a small cancer in their lungs, but all we’re going to do is send them away to lie at home and worry about it for six months, and come back and we’ll do another scan then and then see if any action is warranted. That means we’re asking our patients to live with that gut-wrenching anxiety for months while they wait for the follow-up scan, let alone the small risk of some of those that will be cancers and will have progressed.

“That now changes to us saying, we’ve got a small abnormality in your lung, you can come and have a 20-minute procedure and we have close to a 100 per cent chance of giving you a very clear answer.”

In his operating theatre, a pathologist looks at the samples and can say there and then if it is cancer. In positive cases, the patient can potentially be taken into the next room for robotic surgery to remove the tumour, curing them before they even come round from the anaesthetic.

Routledge said: “That’s a unique lung cancer path, compressing what used to be weeks or months of investigation and treatment into six hours.” The small nodules that can now be reached using the system are likely to represent earlier stage disease, and so researchers hope the technology will improve survival rates. The five-year survival rate for lung cancer patients with cancerous nodules of more than 30mm is around 68 per cent, rising to 92 per cent for those dealt with at less than 10mm.

Professor George Santis, consultant respiratory physician at London Bridge Hospital, said: “Ion’s robotic navigation bronchoscopy will revolutionise the management of lung nodules. This common clinical challenge is relevant not only to lung cancers but other cancers too. This technology will change patient care for the better.”

Kat Lay - Health Editor, Times of London
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