Header image - Alaska Regional’s endoscopy robotics team members with the robotic broncoscopy system.
Presented by Alaska Regional Hospital
Cutting-edge technology at Alaska Regional Hospital is transforming early detection and prevention of lung cancer, the deadliest cancer in the U.S.
Since January, patients have had access to the hospital’s robotic bronchoscopy, a recent advancement in lung cancer detection. This minimally invasive procedure enables doctors to obtain tissue samples from deep inside the lungs — a feat previously achievable only through major surgery — in order to test those cells for cancer.
“This is a game changer,” said Hope Austin, robotics program coordinator at Alaska Regional. “I’m very passionate about this technology because of the number of people’s lives that could be saved.”
November is Lung Cancer Awareness Month. At Alaska Regional, the new robotic bronchoscopy procedure is part of a larger effort to detect and prevent lung cancer. A lung nodule program has also begun identifying high risk patients, recommending CT scans and following patients’ care plans. The team’s mission is crucial in Alaska, where about 1 in 5 people smoke.
“The program is new and it’s so important because there are so many patients who could benefit from it,” said Melissa Almazan, lung nodule coordinator at Alaska Regional.
The first step in lung cancer prevention is screening, which has always been quick and painless.
Screening 101: Am I at high risk for lung cancer?
Lung cancer is notoriously challenging to detect in its early stages. Cancer forms in tiny nodules in the lungs, deep in the bronchial tubes, and patients are often asymptomatic until later on.
In part because it is hard to catch early, lung cancer is the leading cause of cancer deaths. More people die of lung cancer than of colon, breast and prostate cancers combined.
“If we can detect lung cancer in the early stages, before it spreads outside of the lungs, it is easier to treat and the survival rate skyrockets,” said Austin. “Your survival rate is much, much better.”
That’s why screening is so important.
The process takes “less than two minutes,” said CT Lead LeeAnn Daviscourt. “It’s painless, quick and easy.”
Patients lie on a table and the machine uses a combination of x-rays and computer technology to produce different 3D images of the lungs. The scan uses one-fifth of the radiation of a standard chest scan.
People who qualify for screenings are those between ages 50-77, current smokers or those who have quit within the last 15 years and are 20 pack-year smokers. Anyone who meets these guidelines is encouraged to speak with their primary care physician about screenings.
In Alaska, lung cancer screening holds particular importance. Smoking among Alaska adults has declined significantly in the last 25 years, from around 27% in 1997 to 19% in 2020, according to the 2022 Alaska Tobacco Prevention and Control Program.
Despite these successes, Alaska still has higher rates of smoking than the national average. Around 103,200 adults in Alaska today are at risk for poor health outcomes due to cigarette smoking.
For lung cancer prevention, screening is the best way to achieve peace of mind.
“It’s ok to be a little nervous. We are here to take care of you. That’s what we’re trained to do,” said Daviscourt.
After a CT scan has been taken, Almazan, the lung nodule coordinator, reviews it for abnormalities. If she finds any nodules that need to be examined further, she reaches out to the patient and their physician to ensure proper follow up take place.
Most nodules are harmless. Only 2-4% are cancerous, said Austin. The robotic bronchoscopy makes it easy to check whether the flagged nodules are benign.
After six months, Almazan follows up with each patient. She tracks patient cases for at least two years, making sure they get the recommended procedures and communicating with primary care physicians.
“I help the patient and their caregiver navigate the process to ensure the care that is needed is being received,” said Almazan.
Robotic bronchoscopy: Revolutionizing lung cancer care
Dr. Ravinder Shergill is a pulmonologist at Alaska Regional. Lung cancer detection technology has made significant advances in his 33 years of practicing medicine.
The new robotic bronchoscopy is like “apples and oranges” to a traditional bronchoscope, said Dr. Shergill.
For a robotic bronchoscopy, surgeons use a controller to navigate a robotic arm down the trachea and into the lungs. The narrow tube is highly flexible and has four cameras on its end. A live 3D image of the lungs is created by the device that guides surgeons to the suspect nodules.
The robot’s incisions are extremely precise and can capture nodules as small as 5 mm in the lung’s furthest peripheries.
Traditional bronchoscopes utilize the same basic procedure, but without a robotic arm. Surgeons manually hold the tube, which is far less agile, reaching into only larger portions of the lungs.
“I would not even try going after the lesions I do now,” said Dr. Shergill of the traditional bronchoscope.
A patients’ only option was to wait three months and reassess the situation or get surgery. Both surgeries, a lobectomy or wedge resection, are major surgeries that come with an overnight stay in the hospital and increased risk of complications.
“The robotic bronchoscopy eliminates having to get a major procedure,” said Austin.
For the patient, the robotic bronchoscopy procedure is straightforward. Patients lie down on a table and are given a blanket before being given anesthetic that puts them to sleep.
“We have a wonderful team who will make sure that you’re comfortable,” said Daviscourt.
Surgeons remove the nodules and send them out for biopsy. Patients are out of the hospital in about four hours and have results in about 10 days.
If the cells are found to be cancerous, doctors will go over treatment options. As with all cancers, the earlier it is caught, the better the chances of survival.
‘it’s phenomenal’: artificial intelligence expands access to lung cancer detection
Alaska Regional is also using artificial intelligence to expand access to lung cancer screenings. Now, patients that arrive at the hospital for unrelated reasons, such as a car accident or pneumonia, have CT scans automatically examined by an AI program. Any nodules over 6 mm are flagged and sent to Almazan.
“It’s phenomenal,” Austin said of the technology.
In October, a patient visiting Alaska from the East Coast arrived with a broken rib. He received a CT scan during his treatment in the emergency room and continued with his trip. By the time he got home, the AI program had flagged a nodule in his lungs. Almazan called to let him know and she sent the scan to his primary care doctor.
“He was so thankful that this was brought to his attention and that his physician was notified as well,” Almazan said.
As technology continues to advance and the team grows its experience with the new procedure, lung cancer will only become easier to treat, Dr. Shergill said.
Another form of prevention is good self-care, he said. Smokers will see immediate health benefits upon quitting. And everyone can build endurance in their lungs through exercise, even people whose lungs are damaged from smoking. It is never too late.
“Prevention is better than cure,” said Dr. Shergill.
People may be hesitant to be screened for lung cancer for any number of reasons. Dr. Shergill assures patients that the peace of mind is worth it.
“I tell my patients, ‘let’s find out. If we find something, we’ll fix it. If it’s nothing, there will be no need to live in fear,’” said Dr. Shergill.
Alaska Regional has been fulfilling the medical needs of Alaskans since 1963. Alaska Regional is proud of its ongoing commitment to providing the highest quality healthcare in Alaska. From starting lives to saving lives, one generation to the next.
This article was produced by the sponsored content department of Anchorage Daily News in collaboration with Alaska Regional Hospital. The ADN newsroom was not involved in its production.