BWH surgeons prepare for the first image-guided Video-Assisted Thoracic Surgery (iVATS) procedure in the AMIGO suite.

BWH’s Advanced Multimodality Image Guided Operating (AMIGO) suite is known for pioneering image-guided surgical procedures and the advanced technologies that make them possible.

Now, AMIGO can add image-guided Video-Assisted Thoracic Surgery (iVATS) to its list of achievements, after BWH’s Raphael Bueno, MD, associate chief of the Division of Thoracic Surgery and vice chair of the Department of Surgery for translational and cancer research, performed the first successful iVATS case in the world earlier this year.

Video-Assisted Thoracic Surgery, or VATS, is part of the standard of care for removing lung tumors. The surgeon uses minimally invasive video technology to enter into the chest cavity and explore the lung; however, locating the tumor usually relies on previous CT imaging and finger palpation of the lung. This is then followed by surgically resecting, or removing, the affected lung tissue. On occasion, the surgeon ends up removing a larger portion of the surrounding normal lung tissue than may be optimal, in order to ensure complete cancer removal.

The iVATS procedure has been developed at BWH with funding from Siemens Inc. The idea behind iVATS is to couple real-time CT imaging of the lung with video technology to locate the tumor and then surgically cut it out. With the lung inflated, the patient undergoes CT imaging to definitively identify and locate the suspected tumor, which is then marked by special wires. With the lung deflated, these wires guide the surgeon to the precise area in the lung where the tumor is located. This is particularly useful to identify smaller tumors, which are hard to palpate.

“This is a new application of existing technology that will likely change thoracic surgery techniques and lung cancer treatments for the better,” said Bueno. “Past applications of fluoroscopy and angiography—which use a system of guided wires, catheters and a contrast agent—have been used to remove breast tumors and perform catheterizations, but the use of a wires intraoperatively for treatment of lung cancer is innovative and game-changing.”

Added Bueno: “The AMIGO team made history with the successful completion of its first iVATS case. It is a testament to the team effort that went into introducing this new procedure into the AMIGO program and continued efforts to push the boundaries of innovation, which is part of the mission of BWH.”

This operation was done as a part of an approved clinical trial at BWH.