session 1: thoracoscopic lobectomy presentation subtitle here · 3d printing enables novel...
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©2014 MFMER | slide-1
Innovative Technology and instrumentation…
Shanda H. Blackmon, M.D., M.P.H., FACS
Duke Masters of Minimally Invasive Thoracic Surgery 2016
©2014 MFMER | slide-3
Objectives
• Review new enabling technology available for thoracoscopic lobectomy and lung cancer treatment
• Discuss advantages of the new technology
• Discuss potential pitfalls in the new technology
©2014 MFMER | slide-4
Outline
• Approaches
• Robotic Evolution
• Instrumentation
• Stapling
• Staging
• Nodule Localization
• Imaging
• Energy
• Ablation
©2014 MFMER | slide-7
Sib-xiphoid Single-Incision VATS LUL
Chia-Chuan Liu, Bing-Yen Wang, Chih-Shiun Shih, Yun-Hen Liu JTCVS August 2014
*problem: L sided cases- the heart is in the way…
©2014 MFMER | slide-8
New Robotic Equipment
• Stapler
• Smaller Platform
• XI
• Other competitive systems (Johnson & Johnson)
Camera-VATS DaVinci Intuitive S Intuitive SI + teaching concole XI
©2014 MFMER | slide-9
Instrumentation
• Normal instrumentation (McKenna et al.)
• Port placement crucial
• Long double-action curved/articulating (D’Amico et al.)
• Flexible port placement/ more forgiving
• Hand-held devices
• Ergonomic design
• Articulating
• Smaller: 5mm instruments
Normal Instruments Longer double-action curved instruments Articulating
Ergonomic design
©2014 MFMER | slide-11
Instrumentation
• Limiting ports:
• Drop-in clamps and deployable devices
• Trans-fascial suture passing devices
• SILS Instrumentation
©2014 MFMER | slide-13
Instrumentation
• New Suturing Tools
• Robotic suturing
• Knot pushing devices
• Cardiovations
• Scanlan
• TiKnot Device
• Endostitch
• Roticulating Needle Drivers
©2014 MFMER | slide-17
New Stapler Technology
GI Staplers varying height Reinforcement Curve Tip Robotic
• Curved tip stapler
• Smaller profile
• More degrees of articulation/rotation
• Black loads
• Powered stapling
• Smaller hands
• Anvil Fixation
©2014 MFMER | slide-18
Smaller Platform Staplers
• 5mm stapler platform
©2014 MFMER | slide-22
New Scope Technology
Low Definition High Definition 3-D Holographic/submersive
©2014 MFMER | slide-23
How do we do better staging of mediastinum?
• EBUS
• New N1 EBUS scope coming…
Mediastinoscopy CT Video med PET EBUS N1 EBUS
©2014 MFMER | slide-25
Lung Nodule localization
• Technetium injection (CT-Guided)
• Methylene blue injection with ENB guidance
• Indocyanine green injection
Anatomic Guide CT-Technetium Fluorescence ICG ENB-dye Hybrid
©2014 MFMER | slide-27
Hybrid Room Applications
• GE 750 Imaging System
• Novel Lung Mapping from CT Mapping from Cone Beam CT
©2014 MFMER | slide-34
Segment Localization
• Intraoperative Thermography to detect intersegmental plane for segmentectomy
CT scan 3-D reconstruction 3-D printing Thermography
©2014 MFMER | slide-35
Imaging Segmentectomy
• Varian (JTCVS)
3-d segmental
visualization to
detect and plan
segmentectomy
©2014 MFMER | slide-36
Pre-op planning for segmentectomy
©2014 MFMER | slide-37
(A) A 3-dimensional computed tomographic image of the right pulmonary vessels.
Hagiwara M et al. Eur J Cardiothorac Surg 2014;46:e120-e126
© The Author 2014. Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
©2014 MFMER | slide-38
(A) The 3-dimensional computed tomographic image of the right pulmonary vessels showed
that this patient had triple middle lobe pulmonary artery branches.
Hagiwara M et al. Eur J Cardiothorac Surg 2014;46:e120-e126
© The Author 2014. Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
©2014 MFMER | slide-39
3D Imaging
Blackmon 2014
• Chest wall cases
• Complicated anatomy
• Pancoast cases
©2014 MFMER | slide-49
Lung Ablation- we may not always ne resecting by VATS…
• Cryo
• MWA
• RFA
• SBRT
XRT RFA SBRT Cryo MWA
©2014 MFMER | slide-50
Cryospray Therapy
• Pleural application
• Endobronchial application
• Clinical trials
• Early results
©2014 MFMER | slide-51
New Technology that may change the way we treat lung cancer outside of surgery…
• Ablation
• SBRT
• Targeted Therapy
• Screening
• Prevention
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