The latest news in cancer treatment involves Firefly Fluorescence Imaging software and dye, a technology that allows surgeons to see which lymph nodes are first in line from the area where the cancer is growing.
The developer has initiated clinical trials for minimally invasive hysterectomies for cervical and uterine cancer. MountainView Hospital, 3100 N. Tenaya Way, is one of four sites in the country involved in the clinical trial.
“A lot of times, you hear people say they need to leave town for state-of-the art health care,” said Alexis Mussi, vice president of surgery at MountainView. “I don’t know that people realize how talented our surgeons are here.”
The other study sites include hospitals and academic medical centers in Indiana, North Carolina and Michigan. The procedure is used in conjunction with MountainView’s $1.6 million da Vinci Surgical System, a robotic surgery assist technology, to perform complicated gynecologic procedures through several tiny incisions. Firefly causes sentinel lymph nodes to glow in a near-infrared light provided by a special camera.
“Think of seeing really fine lines that are lymphatic channels and little pea pods, which are the lymph nodes, lit up like a Christmas tree in neon green light,” said Eleanor Markle, robotic program coordinator at MountainView. “This gives surgeons the potential to see the sentinel nodes, the first lymph nodes, in the lymphatic tree from the cervix.”
Lymph nodes are part of the body’s natural drainage system, following the network of our blood vessels. Surgeons will often remove particular lymph nodes along with cancerous tumors to stop cancer from spreading.
On April 24, View sat in on an afternoon surgery as Dr. Lynn Kowalski, medical director of the hospital’s robotic surgery program –– known as the Las Vegas Institute for Robotic Surgery –– performed a full hysterectomy on a patient diagnosed with endometrial cancer.
Once the patient was prepped and all parties were apprised of the diagnosis and procedures to be performed, the start time was noted, and the surgical team snapped into all-business mode. Firefly dye, indocyanine green, was injected into the cervix, where it would spread into the lymph system. Then small incisions were made to allow sleeves for instruments and a camera. Observations were made, and the da Vinci device with its robotic arms equipped with the proper attachments rolled into place.
Then Kowalski settled into the command module of the da Vinci. It afforded her a 3-D view of the pelvic cavity. Her view was magnified 10 times. Her hands gripped control levers, their sophistication leaps and bounds beyond video game controls, to make precise moves duplicated inside the body by the robotic assist technology.
TV monitors around the room allowed her team of about seven to see exactly what she was doing inside the abdomen.
When Kowalski was ready to pinpoint the suspect lymph nodes by using Firefly technology, the lights were shut off or dimmed. Everyone turned to the TV monitors, which blinked as the full-color shot was replaced by a mostly black and white image. It was broken by a glaring, bright lime green slash that lit up the screen –– the cancerous lymph nodes.
The surgeon switched back to normal mode and began cutting away the cancer-saturated tissue. She switched back and forth between the full-color and fluorescent modes as she worked, ensuring that she was getting all the affected lymph nodes.
Before the Firefly technique, Kowalski said it was difficult to tell which lymph nodes were involved.
“The standard was that you remove all the lymph nodes in a specific anatomical distribution,” she said.
The lymph system is aligned with one’s blood circulation pathways. The body needs the lymph system as part of its cleansing system.
“The way lymph nodes work is that we have hundreds of them,” said Kowalski. “They follow all the blood vessels of our bodies. So, they’re like a separate, silent vascular system of which most non-physicians are not even aware are filtering their blood. … We’re interested in the blood supply to the uterus. The same concept has been around a long time, and we’ve really borrowed this from breast cancer. That’s where a lot of the headway has been made.”
Kowalski has been doing robotic surgery since 2005. When she learned that Dr. Emma Rossi, director of the Department of Obstetrics and Gynecology at Indiana University’s School of Medicine, was involved in the Firefly study and more surgeons were being sought for the clinical trial, she was determined to be a part of it. MountainView saw its first Firefly surgery in December.
The April 24 surgery was Kowalski’s seventh for the Firefly trail. The study does not have a set end date but rather a set number of patients, topping out at 540 nationwide. Kowalski is expected to contribute with about 25 patients a year.
“I think it’s a really big step,” Kowalski said. “If you talk about breast cancer, a long time ago, women who have very serious complications, this horrible swollen arm. Lymphedema can be very debilitating to their life. … It’s a huge advance, yes, but it’s a bit of a paradigm shift, the concept of using this technology to help us identify where we’re going surgically. This is the beginning. I think it’s very much in its infancy. We call it image-guided technology, and I think it’s going to become massively important in the future.”
Contact Summerlin/Summerlin South View reporter Jan Hogan at firstname.lastname@example.org or 702-387-2949.