Eric Goudie

Background

Eric completed his medical degree at University of Montreal where he currently is a PGY-4 in general surgery. He is part of the Clinician Investigator Program and is undertaking a Doctorate in Biomedical Sciences. His research interests focus on energy devices in thoracic surgery. He has presented his work at several national and international meetings. He is first author and co-author on many peer-reviewed publications and has participated in writing a book chapter on the present and future application of energy devices in thoracic surgery. He has received the CIHR Frederick Banting and Charles Best Canada Graduate Scholarship and a scholarship from the Fonds de Recherche du Québec – Santé. Eric is planning on pursuing his training in thoracic surgery after his general surgery residency.

Research Summary

Anatomical lung resection is the primary treatment strategy for operable stage I and II non small cell lung cancer. Lobectomy is either performed by thoracotomy or by video assisted thoracoscopic surgery (VATS). VATS lobectomy is associated with a shorter postoperative length of stay, and significantly less postoperative atrial fibrillation, blood transfusion, renal failure, and other complications when compared with lobectomy via thoracotomy. The two approaches were found to have similar 5-year survival rates.

VATS lobectomy complications include pulmonary vascular injuries (pulmonary artery, pulmonary vein) necessitating urgent conversion to open thoracotomy and even death. Published conversion rates range from 2% to 20%. Pulmonary artery (PA) branch manipulation, stapling and division are the main technical difficulties and danger in VATS lobectomy. Major pulmonary vessel hemostasis in thoracoscopic surgery, including the PA, is typically achieved using endo-staplers. These staplers fire six rows of staples and simultaneously cut in the middle; leaving 3 rows of staples on each side. The staplers are bulky, rigid and have a large footprint making application and stapling of pulmonary vessels awkward, difficult and dangerous. PA manipulation with the endo-staplers is one of the main hesitations of many thoracic surgeons regarding the adoption of VATS lobectomy. According to an analysis using the Nationwide Inpatient Sample (NIS) database in the United States, only 15% of anatomical lung resections were performed by VATS in 2013.

Energy sealing devices are currently safely used to seal and divide systemic vessels, but not for the pulmonary artery. In a pilot study recently published by our group, energy sealing devices achieved effective vascular sealing on an ex-vivo model with the ability to sustain high intraluminal bursting pressures. Sealing and dividing blood vessels with these devices require less manipulation of the vessel, less dissection, and are finer than staplers to apply. Hence, we believe that if we can decrease the manipulation and dissection required by the surgeon on the PA branches, we can make VATS lobectomy safer and therefore more prevalent for anatomical pulmonary resections.

We conducted an animal survival study. We performed 10 VATS lobectomies in 10 adult dogs. All the steps of the procedure were similar to a standard human VATS lobectomy, except for PA branch. We sealed and divided all PA branches with an ultrasonic energy vessel-sealing device. The dogs were kept alive for 30 days and followed for any hemorrhagic complications. All dogs survived 30 days without hemothorax. Necropsy at 30-days did not reveal any signs of post-operative bleeding. Pathology of the sealed PA branches at 30-days revealed fibrosis, giant cell reaction, neovascularization and thermal changes of the vessel wall.

We are currently recruiting patients in a human trial using an ultrasonic energy vessel-sealing device for VATS lobectomy. These results bring new safety data for an eventual widespread clinical utilization of this technology. This has the potential to make VATS lobectomy more prevalent.