It is easy to understand why surgeons and oncologists are so excited about the latest technology in the fight against lung cancer: it means more accurate diagnoses with less risk to patients. That's what it means now; in the not-too-distant future it could mean even more.
The Monarch Platform manufactured by Auris Health is the first FDA-cleared robot for diagnostic and therapeutic bronchoscopic procedures. Orlando Health is the first facility in Florida and one of the first in the United States to put it to use so far. Already more than 40 patients have benefitted from it.
"It's called Robotic Navigational Bronchoscopy," said Juan Escalon, MD, a member of the Thoracic/Head and Neck Cancers Specialty Section at the Rod Taylor Thoracic Care Center. He and his colleagues Luis Herrera, MD, also a member of the Specialty Section, and Mark Vollenweider, MD, section chief for pulmonary medicine at Orlando Health UF Health Cancer Center are the first three physicians in Florida to be trained on the highly specialized technology. Escalon and Herrera are board-certified thoracic surgeons, and Vollenweider is board-certified in interventional pulmonology.
"We already have techniques where we can use cameras to look down the bronchial tubes," said Escalon. "However, traditionally we can only look into the proximal lung, or the first or second divisions of the bronchial tubes. Before this, we didn't have a good way to look farther out into the lungs. This is really significant, because often-times lung cancer lesions are located in parts of the lung that are hardest to reach."
Before this technology, Escalon explained, the only reliable way to biopsy a nodule inside the lung was "for the radiologist to insert a needle from the outside through the skin and the chest and into the lung." While that procedure works quite well, said Escalon, about 10 to 20 percent of the patients who have it done develop pneumothorax, a collapsed lung caused by air leaking into the space between the lung and chest wall. If that happens, a patient may require placement of a tube and several days of hospitalization.
"The great benefit with this technology," said Escalon, "is that there is no incision and we don't have to insert a needle into the patient, which reduces the chance for complications."
The way the procedure works, a patient first has a CT scan to identify the presence of nodules, which may or may not be cancerous. If they are cancerous, it's important to identify that quickly because lung cancer is the most-deadly type of cancer.
"The CT scan is our roadmap; it's like a GPS for the lung," said Escalon. "The patient is asleep on the table, and we make a magnetic field around them. Using that CT scan as a road map, we can go to all the nodules with the camera on the catheter. We can actually see the nodules and get more accurate biopsies, with a much better safety record.
"The robot has two arms that we control," he said. "It's a little like a video game. With the robot, you can hold the catheter in place, and you can turn the camera 360 degrees so you can see all around. You have vastly increased range of motion. So, the robot allows us to control all the movements of this fiber optic scope and to be very precise with it."
Using endoscopic technology to biopsy lungs is not new; Escalon has been doing it for 10 years. "The new technology is the robot," he explained. "Before this technology was here, you would have to use your hand, and couldn't always get to the area you needed to reach, and once you did, you couldn't keep the catheter in place. The robotic technology holds the catheter in place, allowing you to do more."
In addition to the immediate diagnostic value of this technology, the Monarch Platform may also become a tool for treating cancer. "Because the catheter stays put where you have it, it may become a tool that to allows us to destroy tumors in one treatment," said Escalon. "We will be able to biopsy the nodule; diagnose the tissue immediately and burn the lesions with one treatment without having to do surgery or radiation."
So far, the technology has a 90-percent success rate, according to Escalon, meaning that 90 percent of the biopsies performed have yielded positive test results. That, in and of itself, is a major step forward. Next, if on-the-spot treatment becomes possible, you can understand the reason for both excitement and optimism.
