On Cancers the results of a new treatment protocol for patients undergoing robotic thoracic surgery. Hospitalization reduced to 48 hours and home care
The idea born in the middle of the Covid pandemic, when even the goal of the doctors was to keep the sick in the hospital for as little time as possible. So much so that all non-urgent interventions had been suspended and for those considered not to be postponed, such as the removal of a tumor, the great fear of contagion with the virus hovered over all. Cos the doctors of the Thoracic Surgery team of the IRCCS Humanitas Clinical Institute have devised a device that would allow people with lung cancer to be operated on and monitored, reducing as much as possible hospitalization time and the consequent intra-hospital infectious risk.
Now the idea is a reality translated into protocollo New Eras (Enhanced Recovery After Surgery), which consists in remotely following, with telemedicine, patients discharged after a robotic surgery for lobectomy (lung resection, typically for a tumour) thanks to special electronic devices. And the results of the first patient study have just been published in the scientific journal Cancers.
The experimentation
The program started in 2022 as a response to the needs caused by the pandemic, which has pushed hospitals to reorganize routes to protect the most fragile peoplelike cancer patients — he says Marco Alloisio, Head of Thoracic Surgery of the IRCCS Humanitas Clinical Institute —. Even in the surgical field, technology has proven to be a solution for reducing the length of time on the ward, while protecting patient safety. The basis of the program is robotic lung surgery which, due to its minimally invasive characteristics, favors a better post-operative recovery. Hence the idea of following patients at home after discharge, managing to reduce hospital stay days to 2 compared to an average of 5 with traditional surgery.
We decided to use telemedicine and the best technology at our disposal, robotic surgery — explains its creator and coordinator, Edward Buttons, thoracic surgeon of the Robotic Surgery program of the IRCCS Istituto Clinico Humanitas –. This has also made it possible to dedicate more resources, in terms of beds, to patients with lung cancer. The protocol to date has involved 10 patients aged between 18 and 75 with lung cancer candidates for robotic surgery. All had help at home and were able to interact with the electronic device used for television visits.
The advantages
The advantages found are a better recovery after surgery and less pain thanks to remote support from anesthesiologists. The patients also confirmed the ease of following the instructions of the medical and nursing staff from home. During the planning of the path we focused above all on the possibility of reducing the risk of nosocomial infections (starting from Covid and non-Covid pneumonia) and on small inconveniences such as venous accesses or bladder catheters, which are also potentially sites of infection) – says Bottoni – . Furthermore being in hospital often means staying in a room on a ward and being able to move little, especially with the restrictions adopted in the pandemic, reducing the benefits of walking and the freedom to move to recover quickly.
Patient reactions
What surprised the researchers the most was the reaction of those directly involved: Go back homealbeit monitored and with a chest drain, had for everyone a very positive psychological and comfort aspect – adds the expert – . They resume their lives sooner and returning to their environment, they sleep better, move more, increasing the benefit of physiotherapy and treatments. And the assistance of their caregiver is essential in making them feel cared for and well looked after even at home. Obviously with the support of telemedicine, through monitoring and televisits. Among the positive aspects there is then cost savings for the National Health Serviceobtained by reducing the average hospitalization by about three days.
How the new path works: instructions in the hospital
Before the operation, the patient and accompanying person come instructed in detail by the medical staff on the use of the device provided by the hospital. Tests are carried out together with a smartphone and an electronic device to verify that everything works – continues Bottoni -. On discharge day, usually 48 hours after robotic surgery, patients go home with drainage. The device allows direct contact with doctors and nurses, useful for pain monitoring and management. In the letter of resignation, in addition to all the indications to follow, we have a dedicated telephone number for emergencies or information with a doctor who is always available 24/7.
What to do at home
Once home, on the first day every 4 hoursthe patient must measure the required parameters: pressure, saturation, heart rate, temperature. Drainage is always managed via a device on television with the support of the doctor. The second day the parameters are measured again. The third or fourth day you go back to the hospital to remove the drainage (subject to a medical decision on televisitation). The normal follow-up then follows: medication in hospital after two weeks and delivery of the histological examination.
The risks
Isn’t there a risk in going home too early?
A minimal risk always present, but extremely reduced. The patient is constantly monitored and treated as if he were in a ward thanks to the support of the telemedicine platform used. Finally, if needed, a path for rapid re-entry into the ward was provided. At present this path has never been used and no patient had problems in the following 30 days to surgery.
Export the model
What are the next steps? Continue the project and extend the possibility of access to more patients and other specialties to this service – concludes Bottoni -. In a historical era where everyone, or almost everyone, has the possibility of accessing the internet and a smartphone, I strongly believe in the need to make hospitals places of acute care and extend the service throughout the territory by exploiting the possibilities that technology offers us, of course maintaining a high standard of care and safety for people who turn to the national health system. This study is the first to combine telemedicine with thoracic surgery. And, as far as is known in the literature, a treatment path for lung cancer that would allow remote management of the patient has never been created. We would like it to be the progenitor of a new way of assistance in the surgical patheasily reproducible by everyone.
February 16, 2023 (change February 16, 2023 | 11:34 am)
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