The world's first and second robot-assisted extrapleural pneumonectomy for the treatment of mesothelioma have been performed by Dr. Farid Gharagozloo, professor and section chief of thoracic surgery, robotic cardiothoracic surgery and esophageal surgery at the University of Arizona Department of Surgery.
After the first successful surgery at The University of Arizona Medical Center-University Campus on Jan. 9, Gharagozloo performed the same procedure on Jan. 14 on Chandler, Ariz., resident Carlos Tarazón.
Tarazón, 67, had been given no hope by Phoenix doctors when he received the devastating diagnosis of malignant mesothelioma. Mesothelioma is a highly invasive cancer, often linked to exposure to asbestos. The disease occurs in the inner lining of the chest cavity and the outer covering of the lung. It is usually fatal within a year after diagnosis.
Tarazón was told nothing could be done to stop the spread of the disease. He was prescribed palliative care to make him comfortable for his remaining days.
His family, however, refused to give up hope. His children scoured the Internet, searching for the nation's top cancer doctors and any treatments that might help their father. Their search led them to Gharagozloo, an internationally recognized thoracic surgeon in the fields of minimally invasive and robotic surgery, esophageal surgery and thoracic oncologic surgery. Gharagozloo heads the new University of Arizona Health Network Thoracic Oncology Program.
In the highly complex, minimally-invasive procedure, Gharagozloo removed Tarazón’s left lung, diaphragm and part of his pericardium (the covering of the heart) with assistance from the da Vinci Surgical System robot. A new pericardium and diaphragm were created with a synthetic material.
"The impact we are hoping to make is through early detection as well as very advanced minimally invasive therapy for these tumors," Gharagozloo said. "Whether it is lung cancer or mesothelioma, the robot makes it a better oncologic operation and a safer operation."
The robot-assisted procedure dramatically results in reduces blood loss, shortens the hospital stay and lowers the risk of infection and death. It enables the lining of the chest to be pulled away fairly intact, lessening the possibility of leaving cancerous tissue behind.
Without the robot, an extrapleural pneumonectomy is a "very blind operation," Gharagozloo said. The lining of the chest is torn away, causing a loss of up to two-fifths of the total blood supply.
"It is very clear that in the surgery of the chest, the robot is a game change," he emphasized.
"It's dramatic when you see the patient the next day," Gharagozloo said. "It's the difference between a patient on a ventilator and a patient who is sitting there reading a newspaper."
Tarazón is now back at home, puttering in his yard and planning a hunting trip this fall.
Gharagozloo said the robot even aids in determining who is a candidate for surgery. "With the robot, it's almost like putting a microscope in the chest to see the invasion of the chest wall. If it has invaded the chest wall, you should not be operating."
Tarazón spent much of his lifetime in construction and was exposed to asbestos for 20 years. When he began having trouble breathing, he initially was told he had asthma or allergies. When he was diagnosed with mesothelioma, his family was willing to take him anywhere for treatment and were thrilled to find it in their backyard.
"My dad saw the surgery as an option for living," said Adriana Tarazón Weyer, one of his four children.
A goal of the UAHN Thoracic Oncology Program is to raise awareness about mesothelioma, lung cancer, esophageal cancer and other cancers of the chest – and to catch such diseases sooner.
"We want to change the story of mesothelioma," Gharagozloo said of the work of his team.
"The UA has become one of the leading institutions in the country for robot-assisted surgery for heart and lung," said Dr. Rainer W.G. Gruessner, professor and UA department of surgery chairman. "Cardiothoracic surgery is now evolving as a minimally invasive field like many other subspecialties that embrace minimally invasive surgery."