World First: Complete Lung Removal by
Keyhole Surgery

Liam Davenport

January 31, 2020

A 74-year-old man with advanced lung cancer has become the first patient in the world to have an entire lung removed through a small incision in the abdomen, in a pioneering technique developed at a hospital in the United Kingdom.

Giuseppe Arese, MD, PhD, Royal Papworth Hospital, Cambridge, UK, and colleagues performed the non-intubated subxiphoid pneumonectomy in November, but details of procedure were only made public this week.

The team at the Royal Papworth Hospital in Cambridge, with the patient (in suit) at center.

During the 3-hour operation — roughly half the time usually needed for chest surgery — the team made an incision of approximately 5 cm in length between the abdominal muscles so as to avoid the intercostal nerves.

The entire lung was removed through the incision, guided by a camera inserted into his chest, with the tissue compressed into a bag similar to a fishing net.

During the surgery, anesthesiologists allowed the patient to breath spontaneously on a gaseous mix of oxygen, air and sevoflurane, meaning they could avoid both intubation and the use of opioids, and consequently reduce the risk of respiratory complications.

In a statement, Arese said, "This patient had two tumors in his right lung; one across two lobes plus another tumor at the level of the upper lobe. Our only option to achieve a complete resection of the malignancy was to perform a pneumonectomy."

He explained that the subxiphoid approach "has the potential benefit of reducing the surgical impact," which is reduced further by the anesthetic technique, "making the recovery quicker and safer."

As reported in the Sunday Times, Chinmay Patvardhan, MD, a consultant anesthetist at Royal Papworth, said that the procedure was "game-changing."

Aresu praised the team behind the surgery, which included surgeons, anesthetists, nurses, therapists, dietitians, registrars, and radiographers from Italy, India, Lithuania, Ghana, and the Philippines, as well as the UK.

Richard Page, MD, ChM, president of the Society for Cardiothoracic Surgery, London, UK, was quoted as saying that the technique will become widespread and "will find its place in surgery for the chest."

"The problem with going [in] between the ribs is that there are a lot of nerves in the side of your chest. It's sensitive," he explained.

"When you make a cut between the ribs, even if it's a small cut, you bruise the nerves that are there, and that is why you get more pain from chest incisions than other parts of the body."

"In some of those patients, the pain goes on for more than just a few days. It can go on for many weeks, if not many months."

The patient was 74-year-old Raymond Page, a retired milkman from Peterborough, UK.

He said that he felt "special" to have been involved in the pioneering procedure, although admitted to having been "a touch apprehensive" when he was told about the technique.

Despite some pain when coughing for the first day after surgery, Page said he "could walk and move about fine even just a couple of days afterwards, which I really was not expecting."

Georgina Howell, a thoracic oncology specialist nurse at Royal Papworth, attested to Page's quick recovery, saying he "looked amazing" just a short time after the operation.

Page's wife, Jo, agreed. "When we first got to see him in intensive care, we assumed he'd have all these tubes attached, she told the Sunday Times. "Not my Ray. The nurse said, 'I've never had anyone in intensive care chatting before.' "

Noting that Page had already survived bladder cancer, she added, "We've come so far. And I'm hoping we're going to keep going because I don't want to be without him."

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