Robotics and Beyond: Advances in Lung Cancer Surgery

As director of the Division of Thoracic Surgery in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai, Harmik J. Soukiasian, MD, and his colleagues are on the forefront of surgical innovations for patients with early-stage lung cancer.

In recognition of Lung Cancer Awareness Month, the Cedars-Sinai Newsroom sat down with Soukiasian to learn more about the recent surgical advances that are benefiting patients, including techniques he has pioneered.

What are some of the latest trends you have seen in lung cancer diagnosis?

While lung cancer remains the second-most common cancer in both men and women, as well as the leading cause of cancer death in the United States, we have been seeing an increased incidence of younger, nonsmoking women being diagnosed. This is a national trend, and we have also seen it in action here at Cedars-Sinai. In fact, the number of lung resections we have done for nonsmoking females during 2024 is higher than all of 2022 and 2023 combined, and the majority of those patients are women who are younger than 70 years old.

It’s a troubling trend to consider because current lung cancer screening guidelines outlined by the American Cancer Society are only geared toward individuals between the ages of 50 and 80 who are active smokers or have a smoking history of at least 20 pack years.

You pioneered an ‘all-in-a-day’ procedure that includes biopsy and resection for lung cancer masses. Can you tell us about this technique?

The Single Anesthetic Bronchoscopic Biopsy and Resection technique was developed in 2022 to allow for real-time, minimally invasive diagnosis via robotic bronchoscopy, followed by immediate resection when indicated. This means many patients will have to undergo just one procedure, instead of two.

We start with the patient under general anesthesia. Using the Ion bronchoscope-a scoping device directed through the patient’s mouth, into their airway and lungs=alongside a specialized CAT scan that recreates a 3D map of the patient’s airway, we can navigate directly to the mass of cancer cells, almost like we’re following Google Maps walking directions. Once we reach the mass, we biopsy it and send the tissue sample to the lab, where it can be quickly analyzed. This whole process typically takes less than an hour.

If the sample comes back as benign, the patient can be woken up and sent home with follow-up instructions. In this case, they have completely avoided unnecessary, invasive surgery. Alternatively, if the sample is determined to be malignant, the patient remains under anesthesia and, at that time, we perform a robotic-assisted resection.

This process allows a patient with early-stage, malignant disease to ultimately obtain a diagnosis as well as a therapeutic intervention within the same day and with the same anesthetic. This not only cuts down on wait times, but can also help to alleviate the mental anguish that goes along with a delay between biopsy/diagnosis and resection. The shorter the period of time a patient has cancer in their body, the better off they are both physically and psychologically.

This technique is becoming more common, and I have had the opportunity to train physicians all over the world in the practice.

What’s next for minimally invasive lung cancer surgery?

Standard robots used in minimally invasive lung procedures are multi-port, meaning they require four small incisions in the patient’s chest, through which all surgical instruments and a camera are inserted. However, Cedars-Sinai was recently part of a Food and Drug Administration (FDA) trial for single-port thoracic surgery, a technique that involves only a single incision.

The single-port robot that was studied in the trial is now FDA approved and, as the only institution in the Western United States using the device, we are the current leader in this field, performing the majority of robotic, single-site lung resections in the country.

Patients undergoing single-port thoracic surgery often experience reduced postoperative pain, shorter hospital stays and faster recovery times. The technique is gaining popularity due to its effectiveness and the improved outcomes it offers, making it a promising option for various thoracic conditions.

What else should readers know about lung cancer?

Early detection is key in this disease. When we can treat lung cancer surgically, before it has spread, we can greatly increase a patient’s survival rate. Some cases where we are able to fully resect the tumor to remove the cancer will go on to require additional chemotherapy or immunotherapy treatments.

This is why it is important to incorporate multidisciplinary care early in the diagnosis and treatment of the disease. The addition of immunotherapy and targeted therapy in the perioperative setting has led to improved survival for patients. Our multidisciplinary team of surgeons, medical oncologists, radiation oncologists, pulmonologists, radiologists and pathologists meet to discuss the appropriate therapy for each patient for a personalized approach.

That being said, data from the American Lung Association (ALA) says that only 1% of eligible California residents are screened for lung cancer. This is significantly lower than the national average of 6%. I am on the leadership board of the local Los Angeles chapter of the ALA, and one of our missions is to increase awareness for and access to lung cancer screening programs in the state.

Cedars-Sinai’s Lung Cancer Screening Program is an excellent local resource. I would encourage all eligible patients between the ages of 50 and 80 who are current smokers or who have quit smoking in the last 15 years to call our experts today for a screening consultation.