The Latest Advances in Lung Cancer Surgery: Q and A with Dr. Nestor Villamizar
The Sylvester Comprehensive Cancer Center thoracic surgeon discusses how robotic and minimally invasive lung cancer surgeries are helping patients recover faster, experience less pain and benefit from innovative single-incision techniques.
For years, patients with lung cancer and other thoracic cancers were treated with surgeries that required splitting open the ribcage.
Innovators like Nestor Villamizar, M.D., a surgeon at Sylvester Comprehensive Cancer Center and a professor in the DeWitt Daughtry Family Department of Surgery at the University of Miami Miller School of Medicine, have made thoracic cancer surgeries less invasive, using cameras and robots to operate through tiny incisions.
“With minimally invasive surgery, you can do the same complex operations, but you provide the patients with less pain and faster recovery, lower length of stay, and lower complications,” Dr. Villamizar says.
Dr. Villamizar shares about his work in the following interview, which has been edited for length and clarity.
Please tell us about your role at Sylvester.
I’m a thoracic surgeon. The majority of what we do is thoracic surgical oncology, and the main disease we treat surgically is lung cancer. We treat all the other cancers in the chest, except for those that involve the heart and great vessels, which are rare.
What was your path to becoming a thoracic surgeon?
I did my medical school in Colombia. I liked my rotation in general surgery, so I did an elective rotation in cardiothoracic surgery at McGill University in Montreal. I decided to specialize in cardiac surgery outside Colombia, and the U.S. gave me a structured pathway and access to the latest technology.
I did research with a cardiac surgeon at Duke University, where I also went to the clinics of the chief of thoracic surgery, Thomas D’Amico, who is a pioneer in minimally invasive thoracic surgery. During my residency at Duke, I developed more of a passion for minimally invasive surgery. I liked the fact that they were doing complex operations via tiny incisions, and patients went home the following day. That was amazing.
I had my rotation in thoracic surgery during my fourth year, and everything came together.
How has the development of minimally invasive surgery benefitted thoracic cancer patients?
When minimally invasive surgery started, it was in what we now consider simple operations. Those surgeries demonstrated that patients recover faster with fewer complications. Dr. D’Amico and others defined what minimally invasive surgery in the chest meant: As long as you didn’t spread the ribs and used a camera for assistance, that was considered video-assisted thoracic surgery. It didn’t matter how many holes you put in the chest or how big the incisions were. Scientific studies demonstrated that if you didn’t spread the ribs, you didn’t create the sympathetic response that ends up in complications such as cardiac arrhythmia.
Spreading the ribs was also the most painful part of previous operations. Pain in thoracic surgery, especially when you do lung resections, leads to patients not being able to take a deep breath. That leads to atelectasis, when the lung collapses, which leads to pneumonias. With pneumonia, patients who already had part of the lung removed lose more lung capacity. When you reduce pain, you reduce cardiopulmonary complications.
Later, we saw the advancement of robotic surgery, which uses a 3D camera. Robotic surgery instruments have all sorts of degrees of motion, and they allow the surgeon to do more complex operations, like surgeries after patients receive induction chemoimmunotherapy and have a lot of fibrosis.
What research are you working on to continue to improve cancer surgery outcomes and patient care?
I’m now using a single-port da Vinci robotic surgical system to do surgeries with only a single incision under the ribs. The advantage is that we think it’s going to reduce the possibility of neuropathic pain.
With all these advancements in minimally invasive thoracic surgery, we were still seeing neuropathic pain because even little incisions during operations constantly irritate the intercostal nerves traveling between the ribs.
We have a protocol at the University of Miami called enhanced recovery after thoracic surgery, which includes treating nerves with a long-lasting local anesthetic, and patients recover very well. But we think at least 10% of those patients are going to continue having neuropathic pain. It’s not debilitating, but it’s disturbing in their daily life.
By putting an incision under the ribs instead of between them, we’re trying to get similar results to what I do with abdominal surgeries. Patients have some incisional pain that is well controlled with our protocol, but not long-lasting neuropathic pain.
How do you like to spend your free time?
My current sport is biking. The rest of my time is spent with my family. I have three children, so whenever they are on vacation, we try to travel for them to experience new things.
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Tags: cardiac surgery, Division of Surgical Oncology, Dr. Nestor Villamizar, lung cancer, lung cancer surgery, oncology, robotic surgery, Sylvester Comprehensive Cancer Center, thoracic surgery