Advancing the Science

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March 4, 2020

Providers investigate less invasive procedures for lung cancer and COPD

By Advancing the Science contributor
close in picture of bronchoscope threaded into a clear model of lung airway tubes

By Sara Nick

At Mayo Clinic, research and care often weave together. Many times this results in Mayo patients being the first to benefit from novel options for diagnosis or treatment. For instance, pulmonologists are testing the potential for new, minimally invasive procedures to diagnose and treat conditions including lung cancer and chronic obstructive pulmonary disease (COPD).

"The spectrum of this work spans from new device development to clinical practice, all aimed at providing better options for patients," says Sebastian Fernandez-Bussy, M.D., interventional pulmonologist Mayo Clinic in Florida. "Research on these procedures furthers Mayo's commitment to advancing patient care infused with new knowledge and innovative treatments."

Toward a one-stop shop for lung cancer

Dr. Fernandez-Bussy and colleagues led by Janani Reisenauer, M.D., thoracic surgeon and interventional pulmonologist at Mayo Clinic in Minnesota, are assessing the ability of a new technology to diagnose lung cancer.

"Lung cancer starts with a lung nodule, which we can see on a CT scan. But the scan can't tell us whether the nodule is malignant," says Dr. Fernandez-Bussy. "We need a biopsy for diagnosis, but some of the current biopsy techniques are invasive and pose a risk of complications."

Instead, the investigators are finding that a procedure known as robotic bronchoscopy could be used in a minimally invasive fashion to test lung nodules. In this outpatient procedure, a flexible tube attached to a lens and focusing ring, called a bronchoscope, is placed through the mouth of a patient. The tube is guided by a mechanical arm connected to a console and screen. The console provides doctors with precise control over the bronchoscope, allowing them the ability to navigate through tiny airways – less than 5 millimeters in size – to reach a lesion deep in the lung. They believe this technique will result in increased precision and reduced complications compared to current bronchoscopic biopsy methods.

In addition to tumor diagnosis, the experts' eventual hope is that robotic bronchoscopy could be used to treat lung cancer. Bronchoscopic tubes are hollow, allowing specialists to insert a catheter that could be used to deliver various treatments to the lesion.

"Ideally, we envision a one-stop shop someday, where a patient's lung tumor could be diagnosed, staged, and treated in a single, incisionless outpatient procedure," says Dr. Fernandez-Bussy.

Clearing up COPD's cough

According to the Centers for Disease Control and Prevention, approximately 16 million people in the U.S. are living with COPD. This inflammatory lung condition causes obstructed airflow from the lungs, and it's one of the leading causes of disability in the country. Among COPD's conditions is chronic bronchitis, a productive cough that occurs in bouts of three months or more over multiple years.

Dr. Fernandez-Bussy is involved with a multi-center collaboration exploring the use of bronchoscopy to treat chronic bronchitis symptoms and improve quality of life for COPD patients who aren't responding to other treatment options such as medication or inhalers. The procedure involves threading a catheter through a bronchoscope to deliver an electrical field aimed at decreasing the number of goblet cells in the airway, which are responsible for producing mucous and inflammation.

Dr. Fernandez-Bussy also led a team that recently introduced a treatment to improve symptoms and quality of life for emphysema patients at Mayo Clinic in Florida. In emphysema, the air sacs in the lungs are damaged and over time rupture leaving a large air filled cavity. The new treatment, called endoscopic lung volume reduction, uses a bronchoscope to place one-way valves that deflate the ineffective part of the lung, making space for the “healthier” part of the lung to work. In 2019, Mayo was the first medical center in Florida to perform this minimally invasive treatment. Mayo Clinic in Florida and Rochester are two of only a few medical centers nationwide offering the procedure.

"Mayo's close ties between research and technology, and the teamwork between specialists here, make it possible for us to bring state-of-the-art lung treatments to patients," says Dr. Fernandez-Bussy.

Watch this video to learn more about robotic bronchoscopy.

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Tags: chronic bronchitis, collaboration, COPD, emphysema, Innovations, Janani Reisenauer, lung cancer, minimally invasive procedure, News, pulmonary and critical care medicine, pulmonology, robotic technology, Sebastian Fernandez-Bussy, team science

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