THE TRADITIONAL APPROACH to thoracic surgery, which involves making a large incision in the chest and cutting through bone and muscle tissue, has long been used to treat or repair a wide range of conditions. Though effective and still widely practiced today, this “open” surgical approach presents several drawbacks to patients, including significant pain at the incision site and a relatively long healing and recovery period.
The good news for individuals in our community who require thoracic surgery is that the expert and highly experienced thoracic surgeons at Mercy Health offer cutting-edge alternatives to traditional surgery that address these problems, including both minimally invasive and robotic procedures.
For those unfamiliar with the term, Mercy Health cardiothoracic surgeon Karl Borsody, MD, explains that thoracic surgery applies to any surgical problem related to the chest, including the lungs, esophagus, chest wall, and heart. “Everyone thinks our job is about heart surgery, but about half of what we do involves the lungs or other organs of the chest,” he states. In fact, the most common reason patients end up under Dr. Borsody’s surgical care is cancer or infection of the lungs.
A native Ohioan, Dr. Borsody attended medical school at the Medical College of Ohio (now UTMC), completed his residency at Loyola University Medical Center, and practiced for over 12 years in Dayton at Kettering Cardiothoracic & Vascular. He joined the Mercy Health – St. Vincent Hospital cardiothoracic surgery program six months ago and is thrilled to be back in the Toledo area.
Among the minimally invasive thoracic surgical procedures the Mercy Heath team performs, often in patients with lung or esophageal cancers, is video-assisted thoracoscopy, or VAT. According to Dr. Borsody, “This procedure involves making several small incisions between the ribs and inserting long, thin instruments into the chest to biopsy or remove pathologies. Compared to traditional open surgery, VAT causes a lot less pain because there’s no spreading of bony structures or splitting of muscle, hospitalization is significantly shorter, there’s less blood loss, and it’s generally less taxing on patients both inter-operatively and post-operatively. In addition, the outcome is much more aesthetically pleasing compared to open surgery, which is a very important consideration for many patients today.”
An even more advanced iteration of minimally invasive thoracic surgery practiced at Mercy Health is a robotic approach using the state-of-the-art da Vinci® system. “This system was originated for addressing abdominal problems but has now been adopted for the chest to not only biopsy but also remove questionable nodules and cancer, lymph nodes, and mediastinal masses,” Dr. Borsody says.
The robotic approach is similar to VAT in that the instrumentation is inserted into the chest cavity through very small incisions, thus minimizing pain, bleeding, and healing time. But in addition to these benefits, using the da Vinci system provides vastly improved optics with 3D camera visualization and a high degree of magnification that allows the surgeon to see very tiny structures clearly. The robotic system also improves the surgeon’s fine motor control and reduces natural hand tremor for greatly enhanced precision of movement. Another benefit of the da Vinci system is that it allows for the use of many different instrument types, all of which are articulated at the tip, providing full range of motion in a very tiny space. “Think of it as having a tiny hand at the end of each instrument,” states Dr. Borsody.
Most patients are considered candidates for these minimally invasive procedures, with just a few exceptions, including those who are having repeat surgeries, those who have had prior cardiac or lung surgeries, and those who have a mass that can’t be accessed using minimally invasive techniques.
Dr. Borsody notes that the outcomes for these procedures are equivalent to those of traditional open thoracic surgery—because regardless of the approach used, the Mercy Health surgeons strive to achieve the same high-quality results for every patient.
With lung cancer patients figuring so prominently in his patient caseload, Dr. Borsody urges people to avoid or give up smoking—the cause of the vast majority of lung cancer cases—and live a healthy lifestyle. Those who do smoke may be candidates for low-dose CT screening, which can detect lesions in the lungs very early on before they spread and when they’re easy to treat and potentially cure. The Mercy Health – Lung Nodule Screening Program, headed by Mercy Health critical care pulmonologist James Tita, DO, offers low-dose CT scanning in eight locations throughout our community and screens hundreds of individuals for lung cancer each month.
Low-dose CT screening is recommended for individuals between the ages of 50 and 80 who have at least a 30-pack-year history of smoking (the equivalent of smoking one pack of cigarettes per day for 30 years or two packs a day for 15 years) or who quit smoking less than 15 years ago. This service is now covered by Medicare, Medicaid, and commercial insurances.
“If you smoke and you’re concerned about your lung cancer risk, you have a family history of lung cancer, or a spot was seen on a chest x-ray, it’s important to be screened. Also, watch for signs such as shortness of breath, coughing up blood, fatigue, and unexplained weight loss, which are common symptoms of lung cancer,” says Dr. Borsody.
For more information about Mercy Health cardiovascular services, visit mercy.com.