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Technology Makes Lung Cancer Surgery Less Invasive

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http://suburbanjournals.stltoday.com/ar ... _1.ii1.txt

By Sandi Villarreal

Lung cancer is the most common cause of cancer death in both men and women. Surgery to remove cancerous tissue can be disfiguring and painful with an extensive recovery period.

But that doesn't have to be the case, says Dr. Hon Chi Suen, a new cardiothoracic surgeon at Barnes-Jewish St. Peters Hospital.

He's been at the hospital for about three months, and in that time he's performed two video-assisted thoracic surgeries - or VATS lobectomies.

VATS lobectomies provide a less aggressive surgery with limited scarring and a much shorter recovery period, Suen said. And it's available right here in St. Charles County.

"I think it's important for the public to know that in suitable patients we can do this in a very minimally invasive way," said Suen, who has studied at both Harvard University, Washington University and the University of Hong Kong.

About six weeks ago, Gary Keeney's doctor told him he found a spot on his lung. Fortunately, his doctor knew of Suen. Keeney, 59, and his wife made the hour drive from Union to St. Peters.

"That week before I came to see him, I didn't sleep," Keeney said. "... and after I talked to him, I went home that night and slept well all the way up to when I had my surgery done. He has that calming effect that you understand everything you're going to go through, and it made a difference."

Suen scheduled him for surgery that Monday - Oct. 23.

"In no time, I was in and out and done," he said about three weeks later.

Suen said the best treatment for lung cancer is to completely remove the tumor, but in typical surgeries, that involves making a foot-long incision and cutting through a considerable amount of muscle. Sometimes even ribs are removed for better access.

"When the incision is so big and so many structures are being cut, just the incision itself before you go and remove the lung cancer, the trauma is already severe," Suen said. "The patient will have a lot of pain, and it takes a long time to recover."

Because VATS lobectomies involve using video cameras, large incisions aren't necessary. And BJC-St. Peters recently shifted to high definition cameras so doctors can see the area more clearly.

"With a video camera, the data transmits digitally and you magnify and can produce it on several screens," Suen said.

Surgeons, nurses and others assisting can see what the surgeon is doing throughout the surgery.

Suen said for a VATS lobectomy, three to four small incisions are made, and a scope is inserted in one incision. Small instruments are passed through the other incisions. The lung being operated on is deflated to allow working space, and the surgeon separates the lobe affected by the cancer.

Suen said the surgeon inserts a plastic bag in the chest, puts the lobe inside the bag and enlarges the incision just enough to pull the bag out.

"It's with these kinds of specialized miniature instruments and also technology and knowledge and skill, one can actually do a lung cancer removal just through very small incisions," Suen said.

And what about recovery time?

"Probably Tuesday morning sometime, they took the epidural out of my back for pain because I didn't really have any," Keeney said. "Then they took the oxygen out because I didn't need it. And I've never really had pain."

Keeney spent a total of eight days in the hospital, but by the second day he was already walking the halls.

"One day I walked for about three hours with the guard," he said. "... I felt great."

Keeney said he plans to return to his job as a machinist at GKN Nov. 27.

Video-assisted surgeries have been implemented in many areas, mainly abdominal, over the past 10 years. But Suen said the VATS isn't as prevalent.

"It's not completely brand new, but as far as I know, there are very few surgeons in St. Louis who really do this," Suen said.

Suen said patients have come from all over Missouri and Illinois to see him for lung cancer surgeries.

"We're trying to get people to see that you don't have to cross the river," said Suzanne Shenkman, communications and marketing manager for BJC-St. Peters. "... You can get quality, world-class health care right here in St. Charles County."

Patients who are suitable for VATS lobectomies must meet certain criteria.

Suen said the cancer can't be very sizable.

"If physically, it is very big, then you still need to make an adequate incision to remove it," Suen said.

Also, the cancer can't be spreading to other vital structures, such as a major artery or organ.

Suen said the reason VATS lobectomies aren't done more often is the skills and risks involved. The pulmonary artery, which runs from the heart to the lungs, is very delicate.

"To do this thorocoscopically, you need different type of skills," Suen said. " ... It's about 2.5 liters that go through one lung each minute, so if you make a hole in the pulmonary artery, it's a dangerous thing."

Suen has performed 17 VATS lobectomies during his career and two at BJC-St. Peters.

"So much of what he brings to our hospital has so much benefit to the average consumer in the types of surgeries he does in terms of quick recovery, less pain," Shenkman said.

With the opening of the Alvin J. Siteman Cancer Center last year, BJC-St. Peters is proving itself as a contender in the St. Louis metro area health-care arena.

"If you think about individuals that have cancer and how much more fatigue they have, making that hour-plus roundtrip on a weekly basis either to get radiation or chemo can be very trying," Shenkman said. "Now that we have our cancer center, people can go for their weekly chemotherapy treatments right here in their backyard."

Because Keeney's tumor was caught so early and removed thoroughly by Suen, he said he won't need chemotherapy or radiation.

"To me it's a miracle," he said.

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I watched this surgery.

Truly amazing. The shame is has to be done early stage. I challenged the doctor I spoke to who performs these surgeries to encourage CT scans at his hospital so that he'd be able to do more of these surgeries.

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