William Emert: Robotic-assisted surgery for esoph­ageal cancer

Jay FitzDowntown, Our Town Health

Millions of Americans experience acid reflux ev­ery day. Most don’t know if it’s severe enough and lasts long enough, in the worst cases acid reflux can increase the risk of esoph­ageal cancer.

When that happens, the symptoms usually become apparent as a slow but dis­tinctive change in one’s usu­al reflux symptoms, or new difficulties with eating or swallowing.

William Emert

William Emert is one such patient who had years of reflux and found out the hard way.

“I thought I was healthy,” Emert says. “I didn’t listen to my body.”

Since his cancer diag­nosis in May 2021, cut­ting-edge treatment includ­ing robotic-assisted surgery at Fort Sanders Regional Medical Center took Emert from a life-threatening ill­ness to the restored quality of life he enjoys today.

Prolonged gastroesopha­geal reflux disease (GERD) can damage the lining of the esophagus, making it easier for abnormal cells to take over and possibly transform into a type of tis­sue called Barrett’s esoph­agus, a condition which raises the risk of esopha­geal cancer.

“I was feeling run-down at work, just feeling bad, weak and tired all the time. I kept ignoring it and ignoring it,” Emert says.

Emert’s wife encouraged him to see a doctor and when he finally did, he was shocked by the news that came from his blood work.

“The doctor said ‘We’ve got to send you to the emer­gency room immediately. You’ve got internal bleeding, and I think you might have cancer,’” Emert recalls. “It blows you away.”

A very large tumor had engulfed the lower third of Emert’s esophagus, draping down onto his stomach. Af­ter the diagnosis of cancer was confirmed, he under­went preoperative chemo­therapy and radiation to shrink the tumor. Surgery was planned to complete the treatment.

Michael Antiporda M.D.

Michael A. Antiporda MD is a fellowship-trained foregut surgeon (special­izing in procedures for the esophagus, stomach and upper small intestine) at Fort Sanders Regional Medical Center. He rec­ommended robotic-assist­ed laparoscopic surgery to remove the tumor and reconstruct Emert’s GI tract in the most minimally inva­sive way possible.

“This is major surgery in potentially treacherous ter­ritory involving the chest, abdomen and neck,” Dr. An­tiporda says. “It’s a highly complex operation that’s not done in high volume in many places, but at Fort Sanders Regional we’re able to do many complicated cancer surgeries like these with good out­comes.”

The Right Hospital

Fort Sanders Re­gional was the first hospital in East Ten­nessee with robot­ic-assisted surgery. The medical center has continually up­dated and added to its robotic program since then. This technology allows surgeons to offer the most advanced and minimally inva­sive procedures for a wide array of indications.

“Mr. Emert under­went robotic transhiatal esophagectomy, which I performed using multiple very small abdominal in­cisions and one small left-neck incision. The robot is clutch for doing an opera­tion like this because it per­mits a surgeon to use tiny incisions to operate com­fortably and safely in what would otherwise be a very tight and limited space,” Dr. Antiporda says.

“The alternative to this type of surgery would have been to make large painful incisions in the upper ab­domen or between the ribs, which take significantly lon­ger to recover from.”

The tumor was removed in August 2021. Although it was major surgery, Emert was able to go home in less than a week, fully realizing the advantage of faster recovery that is often seen with robotic surgery. He was pronounced “cancer-free” on Aug. 14.

Lessons to Learn

Today Emert has a smaller stomach space that limits the amount of food he can eat in one sit­ting, but there are no re­strictions on his diet. His quality of life has returned, and he and his wife go on adventures from fishing to foraging mushrooms.

“I feel great. I had forgot­ten what it was to be healthy because I just got so used to feeling bad,” he says.

William Emert

Through it all, Emert has learned some important life lessons. Among them are the importance of taking time to enjoy and appreciate life, along with the importance of self-awareness when it comes to good health.

“Listen to your body, be­cause your body knows when something’s wrong. I learned the hard way,” Emert says. “I’m just glad to be here, and it wouldn’t have been possible without the doctors that I had. I don’t think I’ve met a better doctor – or per­son – in my whole life than Dr. Antiporda.”

Dr. Antiporda says un­controlled GERD is the most common underlying cause of esophageal type of cancer and it’s important to see a doctor for ongoing reflux that causes pain or trouble swallowing. In the event that a cancer diag­nosis does come as a result of GERD, Fort Sanders Regional Medical Center is ready with the knowledge, experience and tools for the best possible outcome.

To learn more about surgery at Fort Sanders Regional visit FSRegion­al.com/Surgery or call 865-673-FORT (3618).

Robotic-Assisted Lung Biopsies at Fort Sanders Regional

Fort Sanders Regional Medical Center has announced the addition of a robotic-assisted bronchos­copy platform for minimally invasive lung biopsies. This technology is first of its kind in East Tennessee and will allow specially trained Fort Sanders Regional physicians to obtain tissue samples in deep regions of the lung, where many early-stage tu­mors are found.

The shape-sensing ro­botic-assisted bronchosco­py features an ultra-thin, ultra-maneuverable catheter that allows navigation by the physician far into the periph­eral lung. It provides addi­tional stability and precision needed for biopsy compared to manual techniques.

As with other robotic-as­sisted surgery platforms, the physician is in complete control of the robot and nav­igates to the target along a planned path. The catheter can move 180 degrees in any direction to pass through small, difficult-to-navigate airways and around tight bends. The robot’s peripheral vision probe provides direct vision during navigation.

Once the pulmonary nod­ule is reached, the catheter locks in place and a flexible biopsy needle passes through the catheter. After advanc­ing around the bends of the catheter, the needle deploys into the target location on a straight path.

“This technology revolu­tionizes how we approach lung nodules – it’s like GPS for the lungs. It will allow us to reach peripheral areas of the lungs that were difficult or impossible to reach be­fore,” Varun Shah MD, in­terventional pulmonologist, said. “Ultimately, we’ll be able to diagnose lung cancer earlier and start treatment earlier, providing more op­portunity for a successful outcome.”

“Lung nodules are often found in difficult-to-ac­cess locations,” David B. Graham, MD, FACS, a thoracic surgeon at Fort Sanders Regional, said. “This new equipment al­lows our specialized pulm­onologists to obtain an earli­er, more accurate diagnosis. Finding lung cancer earlier allows for earlier treatment and, therefore, better pa­tient outcomes. I’m excited about the benefits for our lung nodule patients here in Knoxville.”

The hospital performed its first lung biopsies with the endoluminal system in mid-February.

Information provided by Covenant Health.

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