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Robotic EPP Procedure a ‘Game Changer’ Says Renowned Mesothelioma Surgeon

Pleural mesothelioma is the most common type of mesothelioma. It is also one of the most difficult cancers to treat. Treatment options will depend on where the cancer is (in this case, it starts in the lining of the lungs, known as the pleural lining), how far it has grown or spread (the stage), and your general health and level of fitness. Unfortunately, because mesothelioma is often diagnosed in its later stages, for most patients surgery may be the only hope for survival.

A type of procedure called extrapleural pneumonectomy (EPP) has been used for decades to treat pleural mesothelioma, but the operation is considered controversial. The goal of the surgery is to remove as much of the mesothelioma as possible or completely remove it. This may be accomplished by removing part of the diaphragm, the diseased lining of the heart, the chest cavity, and a lung. This is just one reason the “standard” EPP procedure is so controversial. Another is the associated risks. They range from significant blood loss and infection to death.

One doctor says it doesn’t have to be this way. He says that there’s a better way to perform EPP—a way that could significantly reduce these risks, decrease recovery times, and send patients home earlier.

Renowned thoracic surgeon Dr. Farid Gharagozloo says that robotic surgery can change the future of mesothelioma treatment. He should know. This innovator in robotic-assisted thoracic surgery performed the first successful robotic EPP in 2013. Thanks to a technological wonder called the da Vinci Surgical System Robot, Dr. Gharagozloo says that during the surgery, the chest lining remains relatively intact as it is pulled out. This means the likelihood of getting rid of all the cancer is significantly improved, and blood loss and the risks of infection and death are lowered.

The stress on the remaining lung is also reduced, patients recover faster, and they return home sooner. In fact, regarding the patient’s condition the next day, Dr. Gharagozloo told the Voice Herald that, “it’s the difference between a patient on a ventilator and a patient who is sitting there reading a newspaper.”

So how does this groundbreaking system work? Like most robots, they do all of the heavy lifting. Their movements are more precise, they allow for better maneuverability during the procedure, and they provide a more magnified view. Says Dr. Gharagozloo, the robot is “a better pair of scissors.” While procedures vary, the robotic surgery process typically involves the following:

  • Throughout the robotic surgery, the surgeon sits at a special console.
  • A very small 3D camera and dime-sized surgical instruments are placed inside the patient through tiny incisions. The camera gives the surgeon a magnified 360-degree view of the operative field.
  • Using the consoles hand and foot controls, the surgeon remotely moves robotic arms attached to surgical instruments. A second surgeon is positioned at the operating table to confirm the correct placement of the surgical instruments.

Though da Vinci has only been used to perform EPP surgery since 2013, Dr. Gharagozloo calls it a “game changer” for mesothelioma treatment. Every 60 seconds, somewhere in the world, a surgeon uses a da Vinci Surgical System to bring a minimally invasive surgical option to a patient. Thoracic surgeons have been using the system for a decade for minimally invasive procedures, and since 2006 for chest cancer surgeries. As more surgeons adopt the system for EPP procedures, mesothelioma patients and the medical community will see even better outcomes.



Bedirhan, Mehmet ALi, Levent Cansever, and Adalet Demir. "Which Type of Surgery Should Become the Preferred Procedure for Malignant Pleural Mesothelioma: Extrapleural Pneumonectomy or Extended Pleurectomy?" Journal of Thoracic Disease (2013): n. pag. National Center for Biotechnology Information, U.S. National Library of Medicine. Web.

Foster, Shelly. "The Extrapleural Pneumonectomy Is a Surgery to Remove the Affected Lung in Patients with Pleural Mesothelioma. The EPP May Extend Life Expectancy and Improve a Patientʼs Quality of Life." The Voice Herald. The Voice Herald, 02 June 2016. Web. 25 Apr. 2017.

"How Does Da Vinci Robotic Surgery Work?" UnityPoint - St. Luke's, Cedar Rapids. UnityPoint Health - Cedar Rapids, 2017. Web. 25 Apr. 2017.

Intuitive Surgical, Inc. - Da Vinci Surgical System. Intuitive Surgical, Inc., 2017. Web. 25 Apr. 2017.

"Meet Farid Gharagozloo, MD, Thoracic Surgeon." Florida Hospital Global Robotics Institute. Global Robotics Institute, 2017. Web. 25 Apr. 2017.

"Surgery for Pleural Mesothelioma." Cancer Research UK. Cancer Research UK, 24 Nov. 2015. Web. 25 Apr. 2017.