Dr Erin Gillaspie Discusses New Lung Cancer Developments, Surgery Technologies

Erin Gillaspie, MD, MPH, FACS, of Vanderbilt University Medical Center (VUMC), discusses new technologies making surgeries on patients with lung cancer tumors easier. She also lists what currently excites her within the lung cancer space.

Gillaspie is a faculty member of VUMC’s Department of Thoracic Surgery and an assistant professor of thoracic surgery. She also presented at The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® event in Nashville, Tennessee, on August 17, 2023.

Transcript

What new technologies are making it easier to conduct surgery on patients with lung cancer tumors?

You'll be able to hear my bias right off the bat in this. I'm a robotic surgeon. I love robotics. I spend a lot of my time actually working with engineers to build new robots, to build new robotic devices, new instruments, and it has been one of the joys of my career to help start up a robotics program.

Some of the advantages that I think, in general, when I think about minimally invasive—and that can include fats, and that can include robotics—is that we're making smaller incisions on patients. Many studies have helped to establish that patients who have these smaller incisions where we're not having to put retractors in their chest, we're not having to shingle their ribs, have less pain. They're staying in the hospital for shorter periods of time, we're not seeing any difference in other morbidities, so atrial fibrillation rates, things like that, which is great. And we can perform the surgeries really safely. So it’s safe, less painful, and we can get patients home sooner, which to me is a huge win.

One of the other huge advantages, in my opinion, when we think about doing minimally invasive procedures, especially when I think about robotics, is I have a 3D viewer, which is incredible. I'm able to zoom in on the anatomy a huge amount to be able to help with the conduct of the surgery, and we have so much mobility and flexibility with the wrists. They basically replicate the movements of human hands in a miniaturized version. This is basically like having a miniaturized version of "Honey, I Shrunk the Kids" style in your chest doing your surgery, which is really extraordinary.

The technology has continued to advance over time to allow us to do more and more complex cases. We have seen this huge increase in minimally invasive surgeries, really, in particular, over the last decade, led by a lot of just really extraordinary teachers and master surgeons around the country who have been going around training people, all of our wonderful mentors, including those that I had, who trained me and my training and allowed me to go out and perform all these surgeries.

We're seeing a huge increase, but we're also seeing an increase in the complexity. We're doing pneumonectomies, sleeve resections, tracheal reconstructions, all sorts of really complex surgery, now minimally invasively, as we've been able to increase our comfort level, our skills, and as the technology has continued to get better.

The other big piece to this, and sort of the opposite end where we talked a little bit before about sort of tissue being a big issue, we've seen a huge expansion in some of the tools that our interventional pulmonologists that we as thoracic surgeons also use, and that's in the form of bronchoscopy. We've seen a huge technological boom in navigational bronchoscopy; so the ability to drive out, in a really accurate way, to lung tissues to sample tumors, using our endobronchial ultrasounds to sample lymph nodes.

Surgically, one of the huge benefits, for me: I love to use the robotic bronchoscope to go out and label nodules for myself that I need to go in and resect, especially those that are subsolid that might not be easily palpable at the time of surgery.

There's a lot of really beautiful technological advancements that have allowed us to really improve our ability to diagnose lesions with high sensitivity and specificity at smaller and smaller sizes, help to stage, help to guide therapy, and then, finally, perform our local interventions, like surgery. So, it's been a really exciting space for all of us.

What are you currently most excited about in the lung cancer space?

I'm excited about everything. I mean, I think the way that we're doing surgery now is going to be completely different 10 years, 20 years from now, and so I'm so excited about the ongoing technological advancements.

I'm really excited about the direct delivery of some of our new drug therapies to the tumors through endobronchial approaches. I am so excited about the expansion and molecular understanding of tumors and more and more drugs coming down the pipeline that we're going to be able to use for patients as we sort of continue to unlock and understand how tumors are being driven and how they're outsmarting our treatments. Cancers are really smart—they figure out how to outsmart our therapies—and brilliant scientists that we have working continue to find new ways to target and attack those new mutations that they're delivering.

I tell you, I think the future for cancer is so bright. To me, one of the greatest joys of my career is getting to celebrate cancer-free anniversaries with my patients. And so I can't wait for more and more and more of my patients to be getting to those 5 years, 10 years, 15 years, 20 years, so that we can celebrate that many anniversaries together.