The most deadly form of cancer in Canada is lung cancer. On a daily basis, about 78 Canadians receive a diagnosis of the disease. Some of them will have one of the lobes of a lung removed by thoracotomy, a standard but risky surgical procedure that requires months of recovery. A less invasive and safer surgical technique, however, cancer will still remain and could spread widely.
At the 99th Annual Meeting of the American Association for Thoracic Surgery, a team of researchers presented a large international clinical study. A thoracic surgeon and researcher at the University of Montreal Hospital Research Center (CRCHUM), Dr. Moishe Liberman and his colleagues revealed that thoracoscopic lobectomy, video-assisted thoracoscopic surgery (VATS), combined with pulmonary artery sealing using an ultrasonic energy device reduced the risk of post-operative bleeding, complications, and pain.
Different from surgery with thoracotomy which involves making a 25 cm incision in the chest of the patient and cutting the ribs, a VATS procedure requires small incisions. A miniature video camera is inserted through one of the incisions. In the two types of surgical interventions, there is a risk of bleeding because the branches of the pulmonary artery are thin, fragile, and are attached directly to the heart.
An Associate Professor of Surgery at the University of Montreal, Dr. Liberman said that courtesy of this clinical trial conducted in Canadian, American, and British hospitals, they have shown that it is possible to safely seal pulmonary blood vessels through ultrasonic sealing and effectively control possible bleeding during a VATS procedure.
At present, only 15 percent of lobectomies around the world are performed by VATS, mainly because of the actual risks of significant bleeding or the surgeon's perception of these risks.
Dr. Liberman indicated that he genuinely hopes that the results of their clinical trial will reassure surgeons about the technical feasibility and safety of this operation and will encourage them to adopt it.
After five years of preclinical research at the CRCHUM, trials conducted on animals, phase 1 and phase 2 clinical trials showing the safety of the surgical intervention, Dr. Liberman and the team have recently completed their extensive international phase 2 clinical trial launched in 2016.
Also, it was able to evaluate the effectiveness of this new technique on 150 patients in eight hospitals across Canada, the United States, and the United Kingdom. 139 of them underwent a lobectomy while the remaining 11 underwent a segmentectomy, the removal of a small part of the lung.
They sealed a total of 424 pulmonary artery branches during the study: 181 using surgical staplers, 4 with endoscopic clips, and 239 using the HARMONIC ACE +7 Shears, designed by the company Ethicon (Johnson&Johnson). With a 3-millimeter jaw at its tips, this high-tech "pistol" allows a surgeon to seal blood vessels by delivering ultrasonic energy.
