Bill MesserschmidtCardiothoracic Surgeon At Bristol Regional Uses Da Vinci For Lobectomies On Lung Cancer Patients

A cardiothoracic surgeon's new application of the da Vinci Surgical System is expanding the innovative care Bristol Regional Medical Center delivers by introducing another technique available nowhere else in the region.

Dr. Bill Messerschmidt, who practices with the Wellmont CVA Heart Institute, recently began performing lobectomies on lung cancer patients using the robotic device. This evolution in lung procedures benefits patients greatly by reducing the length of the necessary incision by 50 percent compared to the next, least-invasive procedure.

This has led to other important benefits, including less pain and scarring, a quicker release from the hospital and a shorter time for patients to return to work. Plus, it is more cosmetically appealing.

Roland Lee, a 77-year-old patient of Dr. Messerschmidt from Grundy, Va., raves about this surgical technique the physician used to improve his life. During his preoperative discussions with Dr. Messerschmidt, Lee was excited to learn about the shorter recovery and reduced expense associated with robotic lobectomy. The result has been excellent, too.

"I've done really well since the surgery," Lee said. "I was back to normal relatively quick, and I even played a little golf. I would highly recommend this procedure to anyone. They would be well satisfied with this procedure."

Acquired through philanthropic community donations to Wellmont Foundation, the da Vinci system has been used at Bristol Regional since 2010. Best known for its four robotic arms controlled by a surgeon sitting at a console several feet from the patient, da Vinci provides a high-definition and 3D field of view. Portions of the body are magnified up to 10 times.

This robotic piece of equipment is giving surgeons the latest - and most desirable - option for performing a lobectomy, Dr. Messerschmidt said.

He said the traditional approach is a standard thoracotomy, which requires an incision of about 10-12 inches starting below the shoulder blade and extending to about the end of the rib cage. In addition to the length of the incision, this procedure is extensive for the patient because the chest wall muscles need to be cut.

A less-invasive procedure that became available was the muscle-sparing thoracotomy, which requires a vertical incision of about 4-6 inches below the armpit. In this procedure, which Dr. Messerschmidt has performed, the chest wall muscles do not have to be cut.

Another option is video-assisted thoracic surgery, which uses a thoracoscope and reduces the incision to a maximum of 4 inches. This procedure includes other smaller incisions that are about a half inch to three quarters of an inch. Dr. Messerschmidt said this procedure is difficult for surgeons because the instruments used to operate in that small space are 12-18 inches long.

When da Vinci came on the market, Dr. Messerschmidt became interested in using it for lobectomies. This approach is attractive because it entails the same small incisions, one of which is expanded to only about 2 inches or 2 1/2 inches at the end of the procedure to remove the lobe.

"The robotic approach is also advantageous because it gives us greater access as well to remove lymph nodes, which could also be cancerous," Dr. Messerschmidt said. "Because of da Vinci's precision and optics, surgeons can perform a more extensive operation for lymph nodes more precisely."

Dr. Messerschmidt said a patient whose lobe is removed robotically goes home about two days earlier than someone with a standard thoracotomy and returns to a job within a few weeks instead of two to four months.

"Plus, in a standard thoracotomy, I would have to insert two chest tubes about the size of my thumb for drainage," Dr. Messerschmidt said. "Now, we just need one, and it's the size of my little finger."

Lee gives Dr. Messerschmidt high marks for the way he handled the case.

"He did a fantastic job with my operation," Lee said. "And he has good bedside manner."

With CyberKnife Robotic Radiosurgery System and the da Vinci system, Bristol Regional has the most advanced robotics in the region. CyberKnife is recognized primarily for its high-quality care of lung cancer patients who need radiation treatment.

The da Vinci system, available at Bristol Regional and Holston Valley Medical Center, is also used to remove cancers of the prostate, kidney and bladder; perform hysterectomies; and treat other benign and malignant gynecological conditions.

Dr. Messerschmidt has expanded the use at Bristol Regional to incorporate a number of cardiac and thoracic procedures, including removal of the mammary artery inside the chest for use in coronary artery bypass surgeries and a single-vessel bypass without splitting the breast bone. Plus, he performed an exploratory thoracic procedure and removed a mediastinal mass.

"We've always wanted to perform the most advanced procedures, help the patient with improved surgery methods and take other steps to decrease risk of pain, morbidity and complications," Dr. Messerschmidt said. "In the case of lung cancer patients, it's very gratifying to develop a new procedure that is less painful and enables them to proceed with the rest of their lives in short order."