Lung cancer surgery has become less invasive over the years, with surgeons increasingly using small incisions and robotic instruments instead of opening the chest to remove tumors. Yet even these newer techniques can come with a painful recovery, in part because the instruments pass between the ribs, where sensitive nerves can become irritated.
At UCLA Health, surgeons are using a new approach called single-port robotic surgery that allows them to remove an entire lobe of the lung (lobectomy) through just one small incision below the rib cage. By avoiding the sensitive nerves between the ribs, the approach could help reduce pain after surgery, lessen the need for pain medication and make it easier for patients to return to their daily activities.
In this Q&A, Jay M. Lee, MD, Surgical Director of the Thoracic Oncology Program at UCLA Health and investigator at the UCLA Health Jonsson Comprehensive Cancer Center, explains how the technology works, why the location of the incision matters and what this new approach could mean for people facing lung cancer surgery.
UCLA recently performed its first single-port robotic lobectomy for lung cancer. What does this procedure involve, and how is it different from traditional lung cancer surgery?
Dr. Lee: A lobectomy removes the lobe of the lung containing the cancer, rather than the entire lung. Traditionally, this could involve open surgery, which requires a larger incision and sometimes spreading the ribs. Minimally invasive approaches, such as video-assisted thoracic surgery or conventional robotic surgery, typically use several smaller incisions through the chest in between the ribs.
With this new approach, we can perform the entire operation through a single incision below the rib cage. In our first case at UCLA, that incision was just 4 centimeters, or about 1.6 inches. We can still remove the affected lung tissue and evaluate the surrounding lymph nodes to determine whether the cancer has spread.
How does the robotic technology work, and what allows surgeons to perform such a complex operation through one incision?
Dr. Lee: During the procedure, I sit at a surgical console and control the robotic instruments while viewing a magnified, three-dimensional image of the surgical area. The camera and instruments enter through the same small incision and can move in different directions inside the chest, giving us the flexibility and precision needed to perform the operation.
One of the key advances is a robotic stapler designed specifically for the single-port system. It allows me to divide and seal blood vessels, airways and lung tissue directly from the console, rather than relying on an assistant to operate a separate device.
The robot doesn't perform the surgery on its own. Every movement is controlled by the surgeon.
Who is a good candidate for single-port robotic lobectomy? Is this an option for everyone with lung cancer?
Dr. Lee: Not every patient with lung cancer will be a candidate for this approach. We carefully evaluate several factors, including the size and location of the tumor, whether the cancer has spread, the patient's lung and heart function, previous surgeries and their overall anatomy.
Patients with certain early-stage lung cancers that can be safely removed with surgery may be good candidates. However, the decision is always individualized.
The most important consideration is making sure we can safely and completely remove the cancer. The number of incisions should never take priority over the quality or safety of the operation. For some patients, another minimally invasive approach or traditional surgery may be the better option.
What can patients expect during recovery after this type of surgery?
Dr. Lee: Even though we're using a small incision, patients are still undergoing a major lung operation, so recovery takes time. We encourage patients to begin walking and doing breathing exercises soon after surgery to help their lungs recover and reduce the risk of complications.
Most patients will also have a temporary chest tube to drain air and fluid while the lung heals. We use an individualized pain management plan to keep patients as comfortable as possible and reduce the need for opioid medications when appropriate.
The length of the hospital stay depends on how well patients are breathing, moving around and managing their pain, as well as when the chest tube can be removed. With single-port surgery, our hope is that patients will experience less discomfort and be able to return to their daily activities more easily.
What does bringing this technology to UCLA mean for patients and the thoracic surgery program?
Dr. Lee: UCLA already has a well-established robotic thoracic surgery program, and we perform many robotic operations each year for lung cancer and other conditions involving the chest. Single-port surgery builds on that experience and gives us another option to offer patients.
At UCLA, thoracic surgeons work closely with medical oncologists, radiation oncologists, pulmonologists and other specialists to develop individualized treatment plans. Having this technology allows us to further personalize the surgical part of that care, with the goal of reducing the physical burden of treatment whenever possible.
How do you see advances in robotic surgery changing the future of lung cancer treatment?
Dr. Lee: Lung cancer treatment has changed dramatically over the past several years. We now have more effective targeted therapies and immunotherapies, better ways to understand the biology of a patient's cancer and increasingly sophisticated surgical techniques.
One of the things we're focusing on is not just how successfully we can remove a tumor, but also how well patients recover afterward. Recovery is especially important for patients who may need additional cancer treatment after surgery. We want them to regain their strength and function so they can move forward with the next phase of care without unnecessary delays.
Single-port robotic surgery has the potential to support that goal by making the operation less physically demanding, although we still need more research to understand its full impact.
Looking ahead, I think we'll see this technology used in a wider range of carefully selected lung and chest operations as the instruments and techniques continue to improve. But the goal isn't to perform every operation through one incision. It's to choose the safest, most effective approach for each patient while minimizing the impact of surgery on their lives.
What excites you most about what this advancement could mean for patients with lung cancer?
Dr. Lee: What excites me most is the possibility of making a difficult experience a little easier for patients. A lung cancer diagnosis is already overwhelming, and surgery can be one of the most intimidating parts of treatment. If we can perform the same cancer operation through a smaller incision, potentially reduce pain and help patients get back to the things they enjoy sooner, that's meaningful progress.
Seeing our first patient walking three miles a day and no longer needing pain medication less than three weeks after surgery was incredibly encouraging. That's the kind of outcome we hope to build on as we continue refining this approach.
Ultimately, it's not about the technology itself. It's about using that technology to provide the best possible cancer care while helping patients recover and return to their lives.
