Skip to main content

Talks with Docs: Brian Mitzman, MD

Read Time: 4 minutes

Video Transcript

I look forward to the day when I don't have to operate anymore. We get to the point where I don't have to remove a lung cancer. That means we've done something right.

I am Dr. Brian Mitzman. I'm a general thoracic surgeon here at the Huntsman Cancer Institute and the University of Utah and I specialize in robotic thoracic surgery.

What is robotic-assisted surgery?

So, there's this misconception that I hit a button and I go get a cup of coffee and the robot does all the work. Robotic-assisted surgery is essentially just like laparoscopic surgery, if you're going to have your appendix out, and the surgeon is using long instruments and a long camera, except the robot is holding those instruments. So, the surgeon is still completely controlling them. We sit in this device where we can control the instruments, but we're able to see in 3D. It's 10 times magnified, and it gives us this precision where the instruments mimic our wrist movement and our hand movements. So, you can do in my mind, better surgery more efficiently, more precisely, more complicated operations that normally we would not be able to do through tiny holes.

What types of robots are used for thoracic surgery?

So, in my world, in thoracic surgery, we really have two robots now. There's the classic robot that you hear about on TV, the Da Vinci, that actually is helping us do the big operations. And then we have a smaller robot called the Ion, which is helping us identify tumors, cancers that are much smaller. 

So, for the Ion specifically, we're able to find these tiny little cancers that normally we would not be able to remove that we would either be watching until they got bigger when they would be resectable, or if we went to remove them, we would have to take out a much bigger piece of a patient's lung tissue. Now we can precisely see exactly where it is and take out a much smaller piece. 

The classic robot, the Da Vinci, in my world it has a lot of benefit. So, as you can imagine the chest, not an easy thing to get into, the ribs are in the way. So, if we want to get our hands inside, we have to make a big incision, sometimes we have to actually break a rib and the recovery can be quite painful. Patients are in the hospital five or six days and it could be several months before patients feeling like their normal self again, going back to work and just feeling normal. 

With the robot, because the incisions are so much smaller, we're able to sneak in between the ribs, do the same cancer surgery we'd be able to do with the bigger incision, shorter time in the hospital, one or two days instead of five or six, much less pain. When I send patients home, I tell them there's no restrictions. Usually they can do anything they want to do, they just have to listen to their body. They can't damage what I did to them. So, it's just listen to your body and get right back to your normal routine. So same cancer outcomes but just a much easier recovery for the patient.

How did you become a thoracic surgeon who specializes in robotics?

During my residency, I fell in love with thoracic surgery. I was participating in cases, and just the anatomy of the chest, the way the blood vessels and the airway all are like a big Rubik's Cube. It's like a big puzzle. That really interested me. I loved the high stakes nature of the operations, but then the massive benefit you can give these patients especially with an early stage lung cancer, where if you do a good job and catch it early, you can really cure them.

What makes you the most excited about the work you’re doing right now?

What I love about thoracic surgery is that it's almost still in its infancy. We are evolving at an exponential rate here, it’s so fast. Ten years ago, when I was in training or finishing my training, everything was still being done through an open incision. If we go back to 2010, 80% of lung cancer resections were through a big incision, where we're breaking a rib, big operation. Now that's down to 20%. So, in just 10 years, especially with the help of robotics, everything has changed.

What do you look forward to about the future?

Because my field is changing so rapidly, whether it's lung cancer or esophageal cancer, our treatments are getting better, our cure rates are getting better, the technology is getting better. I love being at Huntsman Cancer Institute because we're just on the cutting edge of all of that. We are helping the field progress faster. 

I look forward to the day when I don't have to operate anymore. We get to the point where I don't have to remove a lung cancer, that means we've done something right. So that's what we're fighting for every day is less invasive operations and eventually get to the point where an operation isn't even necessary.

Cancer touches all of us.