April 19, 2019 by John Fernandez
Robot Aids in Minimally Invasive Cancer Procedures
Fighting cancer with the help of a robot may sound like the stuff of science fiction. But, in fact, it’s part of some groundbreaking, minimally invasive treatments performed by Baptist Health specialists — even before Miami Cancer Institute at Baptist Health completes its $430 million facility on the Baptist Hospital campus.
Interventional radiologist Ripal Gandhi, M.D., recently performed one of the world’s first robotic radioembolizations for primary liver cancer at Miami Cardiac & Vascular Institute, which is close to completing a $100 million expansion project on the Baptist Hospital campus. (In 2012, Institute doctors also were the first in the world to use the robotic catheter in a tumor embolization, a procedure that cuts off the tumor’s blood supply.)
Pioneering Robotic Cancer Procedures
These pioneering robotic cancer procedures are part of the growing field of interventional oncology, which brings together cancer specialists, radiation oncologists, surgeons and interventional radiologists to give patients the benefits of sophisticated multidisciplinary care. The treatments often are an option to improve survival and extend quality of life for people with inoperable cancer or stage-four cancer that has spread to other organs. In some cancer cases, the treatments can be curative.
Miami Cardiac & Vascular Institute is one of fewer than 10 facilities in the United States equipped with the Magellan Robotic System for endovascular procedures — those that use image-guided catheters that travel through the blood vessels to diagnose and treat aneurysms, stroke, heart problems, cancer and other conditions.
In addition to the interventional approach, Baptist Health’s Center for Robotic Surgery uses the da Vinci System in one of the most robust programs in the country. The robotic instruments are inserted through several small incisions, creating a minimally invasive approach for cancer that can be treated, and often cured, with surgery. With a quicker recovery and fewer complications, robotic surgery is often a good option for gynecologic, prostate, lung, colorectal, kidney and throat cancer.
Because the technology is highly specialized, patients sometimes travel from outside South Florida for this type of care. Dr. Gandhi’s liver cancer patient, for example, lives in Louisiana. Dr. Gandhi had been treating the 80-year-old man for about two years with interventional oncology procedures when the cancer recurred in his liver.
Using the robot requires a great deal of technical proficiency. Sitting at a remote workstation, the doctor controls the delicate movements of the catheter inside the blood vessel. “I’ve used the robotic catheter in other applications and I felt confident it would work well for this procedure,” Dr. Gandhi said. “The patient loved it.”
Radioembolization is a targeted treatment for inoperable liver cancer that combines radiation therapy with embolization. The minimally invasive procedure requires a tiny incision to insert the robotic catheter into an artery in the patient’s groin. After delicately guiding the robotic catheter from the groin to the liver, Dr. Gandhi injected millions of microscopic radioactive beads into the patient’s tumor through the liver artery, also effectively cutting off the tumor’s blood supply.
‘The Robot Lets You Be Creative’
The robotic catheter is designed to allow greater precision, control, stability and flexibility than the hand alone. “The robot lets you be creative,” said Dr. Gandhi, who serves as an associate professor at Florida International University’s Herbert Wertheim College of Medicine. “You can adjust the robotic catheter to any angle and in every projection you want, which is certainly an advantage. This technology offers the potential to make some interventional procedures more precise and safer.”
Situated at the workstation, the doctor and medical team spend less time in the radiation field at the bedside, where they must wear heavy protective lead jackets. The comfortable ergonomic workstation also reduces physician fatigue during the painstaking procedures.
Dr. Gandhi trains other physicians in interventional procedures and writes about the specialty for medical publications. He has used the robot in several other types of interventional procedures for cancer, including chemoembolization, injecting chemotherapy drugs directly into a tumor via the blood vessel that feeds it.
“I have not had any complications related to the robotic procedures,” he said.
The liver cancer patient from Louisiana had a quick recovery from the radioembolization treatment, another benefit of the minimally invasive procedure, Dr. Gandhi said. He can have more interventional treatments, when needed.
“We’ve already beat the odds,” Dr. Gandhi said.