Robotic technology leading to new treatments for lung cancer

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http://www.hospitalnews.com/modules/mag ... 8&AID=1085

By Jayne Graham

A London Ontario thoracic surgeon and researcher is hoping a century old procedure will actually become the way of the future in treating patients with lung cancer. Dr. Richard Malthaner says that the recent increase in minimally invasive thoracic surgery has renewed an interest in the role of robotic assisted brachytherapy for lung cancer.

Brachytherapy, also called "seed implants", is one treatment for certain types of cancers. This method generally refers to the use of radioactive material implanted in a body cavity, where it then gives off continuous low-level radiation to destroy the cancer. In brachytherapy, radioactive "seeds" are carefully placed inside of the cancerous tissue and positioned in a manner that will attack the cancer most efficiently. There are many advantages to this treatment including the avoidance of major surgery, chemotherapy or multiple radiation treatments. As well, the treatment delivers a higher dose of radiation directly to the tumour. For Dr. Malthaner and his research team at CSTAR (Canadian Surgical Technologies & Advanced Robotics), surgical robots are key to ensuring the direct placement of the seeds into the tumour.

Dr. Malthaner is no stranger to the use of robotic technology in the operating room and has a long list of world and Canadian firsts when it comes to minimally invasive and robotic assisted advancements. For example, the world's first 3D- CT scans of lung tumors for preoperative surgical planning, Canada's first robotic assisted resection of a lung cancer, Canada's first robotic assisted lobectomy for lung cancer and the world's first image guided robotic assisted thorascopic resection of a lung cancer using a robotic arm and a 3D ultrasound probe.

Surgical robots such as Zeus and daVinci have been shown to vastly improve laparoscopic surgical efficiency by providing superior magnification (in the case of da Vinci, 3D image), dexterity and improved precision of dissection by tremour filtration and motion scaling. Further, the robots facilitate not only the surgical removal of cancer using thorascopic and laparoscopic techniques, but also enable image guided therapy for more precise consistent and safe implantation of brachytherapy seeds with minimal patient morbidity. Also, only robots can allow the health-care team to implant radioactive seeds at a safe distance from the radioactive source.

Many surgeons have been working on ways to improve robotic brachytherapy procedures. What sets this project apart is in its approach. CSTAR is the only institution in Canada that has minimally invasive surgical robotics for use in research along with the surgical, radiation oncology, engineering and imaging expertise to develop and achieve these objectives. Dr. Malthaner has worked with a team of engineers to develop a brachytherapy seed injector to attach to one of the Zeus robotic arms. The seeds would then be deployed according to the pretreatment planning from a CT simulation. The surgeon would then be guided to the exact position of the seeds with the assistance of the robot using real time 3D ultrasound and an electromagnetic navigation system. The proposed project is unique because it involves the direct implantation using minimally invasive techniques rather than suturing of the seeds into the tumour.

Providing a safe and effective treatment option for lung cancer patients who are not candidates for traditional therapies including surgery, chemotherapy or radiation is important work. The surgical robotic system can provide surgeons with all the clinical and technical capabilities of traditional open surgery while enabling them to operate through tiny incisions. Once these techniques are perfected, Dr. Malthaner expects to perform the world's first clinical procedure in humans with lung cancer.

Lung cancer is one of the most feared of all diseases. Every year the numbers of Canadians diagnosed with lung cancer increases, with this disease being the leading cause of death in both men and women. According to the Canadian Cancer Society, an estimated 6,500 people in Ontario will die of lung cancer in 2005. It is these alarming statistics that keeps Dr. Richard Malthaner and his team searching for better treatments and a brighter future for those with lung cancer.

Jayne Graham is Interim Manager of CSTAR. CSTAR (Canadian Surgical Technologies & Advanced Robotics) is a research program of London Health Sciences Centre and Lawson Health Research Institute.