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Robotic EPP Could Change Future of Mesothelioma Treatment

A type of procedure called extrapleural pneumonectomy (EPP) has been used for decades to treat pleural mesothelioma. The goal of the surgery is to remove as much of the mesothelioma as possible or completely remove it. This may be accomplished by removing part of the diaphragm, the diseased lining of the heart, the chest cavity, and a lung. This is just one reason this “standard” EPP procedure is so controversial. Another is the associated risks that range from significant blood loss and infection to death.

One doctor says there’s a better way to perform the procedure—a way that could significantly reduce these risks, decrease recovery times, and send patients home earlier.

Dr. Farid Gharagozloo, a renowned thoracic surgeon at Florida Hospital, says that robotic surgery can change the future of mesothelioma treatment. He should know. This pioneer in robotic-assisted thoracic surgery performed the first successful robotic EPP in 2013. Thanks to a groundbreaking system called the da Vinci Surgical System Robot, Dr. Gharagozloo says that during the surgery, the chest lining remains relatively intact as it is pulled out. This means the likelihood of getting rid of all the cancer is significantly improved, blood loss is decreased, and the risks of infection and death are lowered.

The stress on the remaining lung is also reduced, patients recover faster, and they return home sooner. In fact, regarding the patient’s condition the day after surgery, Dr. Gharagozloo said, “it’s the difference between a patient on a ventilator and a patient who is sitting there reading a newspaper.”

Like most robots, da Vinci does all of the heavy lifting. They allow for better maneuverability during the procedure, their movements are more precise, and they and they provide a more magnified view. The robot is “a better pair of scissors,” says Dr. Gharagozloo.

Though da Vinci has only been used to perform EPP surgery for the past four years, Dr. Gharagozloo calls it a “game changer” for mesothelioma treatment. Every 60 seconds, somewhere in the world, a surgeon uses a da Vinci Surgical System to bring a minimally invasive surgical option to a patient. Thoracic surgeons have been using the system for a decade for minimally invasive procedures, and since 2006 for chest cancer surgeries. As more surgeons begin to use the system for EPP procedures, mesothelioma patients and the medical community will enjoy even better results.


Bedirhan, Mehmet ALi, Levent Cansever, and Adalet Demir. "Which Type of Surgery Should Become the Preferred Procedure for Malignant Pleural Mesothelioma: Extrapleural Pneumonectomy or Extended Pleurectomy?" Journal of Thoracic Disease (2013): n. pag. National Center for Biotechnology Information, U.S. National Library of Medicine. Web.

Foster, Shelly. "The Extrapleural Pneumonectomy Is a Surgery to Remove the Affected Lung in Patients with Pleural Mesothelioma. The EPP May Extend Life Expectancy and Improve a Patientʼs Quality of Life." The Voice Herald. The Voice Herald, 02 June 2016. Web. 25 Apr. 2017.

"How Does Da Vinci Robotic Surgery Work?" UnityPoint - St. Luke's, Cedar Rapids. UnityPoint Health - Cedar Rapids, 2017. Web. 25 Apr. 2017.

Intuitive Surgical, Inc. - Da Vinci Surgical System. Intuitive Surgical, Inc., 2017. Web. 25 Apr. 2017.

"Meet Farid Gharagozloo, MD, Thoracic Surgeon." Florida Hospital Global Robotics Institute. Global Robotics Institute, 2017. Web. 25 Apr. 2017.

"Surgery for Pleural Mesothelioma." Cancer Research UK. Cancer Research UK, 24 Nov. 2015. Web. 25 Apr. 2017.