2018-19 Cancer Network Annual Report

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Greater precision through newer technology: Gregory FitzHarris, M.D., Colorectal Surgery, Sentara CarePlex Hospital

Surgical Techniques

Complex procedures, proven outcomes

Our highly trained surgeons specialize in numerous minimally invasive, innovative surgical techniques that reduce complications and recovery time for patients. In many cases, small incisions replace larger surgical wounds that require more healing.

Our expertise comes not only from Sentara Cancer Network surgeons, but also from renowned experts at medical centers that partner with us to deliver exceptional care to our patients. We invest in the latest equipment and are committed to ongoing education to stay at the forefront of cancer treatment technology and techniques.

da Vinci® surgical robot for gynecology, head and neck, urology and colorectal surgery

Sentara CarePlex Hospital, Sentara Leigh Hospital, Sentara Norfolk General Hospital, Sentara Northern Virginia Medical Center, Sentara Virginia Beach General Hospital

The da Vinci robot empowers a surgeon to perform a precise, nerve-sparing operation through several dime-sized incisions. With this minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery.

The robot dramatically enhances visualization by presenting a 3D view rather than a two- dimensional view from traditional laparoscopic surgery. The precision, control and dexterity offered by the da Vinci system allow physicians to perform complex surgery in a more effective manner than open surgery or traditional laparoscopic surgery.

For example, head and neck cancer teams at our quaternary facility, Sentara Norfolk General Hospital, use the da Vinci surgical system to perform transoral robotic surgery, a significantly less invasive treatment for cancers in the voice box, throat and tongue. Surgeons use the advanced components of the da Vinci robotic surgery system, and patients benefit with less trauma, faster recovery, shorter hospital stays and fewer scars.

Additionally, use of the da Vinci prostatectomy surgical robot has revolutionized prostatectomy surgery by making it a more precise, minimally invasive procedure with excellent results. One of the most common treatments for prostate cancer, traditional radical prostatectomy, requires an 8- to 10-inch incision which results in substantial blood loss, a lengthy recovery and the risk of impotence and incontinence.

Getting closer with managing microscopic cells: Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Sentara CarePlex Hospital, Sentara Norfolk General Hospital

Complex and advanced abdominal cancers are difficult for physicians to treat because cancer cells are woven through the thin membranes of the peritoneum that wraps around the abdomen and internal organs. These microscopic cancer cells are often left behind during surgical procedures that remove abdominal tumors. However, the cells are now reachable: HIPEC uses high doses of chemotherapy to penetrate and destroy the cancer cells that remain after surgery. Physicians apply the high-dose solution of chemotherapy locally within the abdomen, minimizing side effects and improving absorption.

HIPEC perfusion: Reaching previously unreachable cells

They can also administer HIPEC as a palliative measure to help control the disease and prevent fluid collection.

Expanded options: Neurosurgical oncology

Sentara Norfolk General Hospital

New surgical advances for brain tumors are offered at our quaternary hospital:

  • With endoscopic neurosurgery, surgeons can access lesions and tumors that may have previously required an open craniotomy.
  • Intraoperative brain mapping allows surgeons to map functional areas of the brain and remove a tumor without damaging critical areas.
  • Using the 6 Pillars Approach to removing brain tumors, a six-prong process that features the NICO BrainPath, surgeons provide greater precision and safety to patients.
  • The NeuroBlate® system offers minimally invasive robotic laser thermotherapy with MRI-guided neurosurgical ablation. The system also gives surgeons real-time imaging to ease quick decision making.
  • Doctors can slow or stop cancer cells from dividing for at least 18 hours a day in patients with recurrent glioblastoma with the Optune™ portable medical device’s alternating electric fields.

Making a major surgery more manageable: Minimally invasive pancreaticoduodenectomy

Sentara CarePlex Hospital

Pancreaticoduodenectomy, often called the Whipple Procedure, involves the removal of part of the pancreas, a portion of the bile duct, the gallbladder and the duodenum. This major operation is now performed at Sentara using a minimally invasive technique, offering the benefits of smaller incisions and faster recovery.

A quicker return home: Minimally invasive esophagectomy

Sentara Leigh Hospital

This technique for removing esophageal cancer gives patients significant advantages over a traditional open esophagectomy. The procedure requires surgeons to be specially trained with advanced laparoscopic and thoracoscopic techniques. The approach results in potentially less blood loss, fewer blood transfusions, shorter hospital stays and quicker recovery.

Smaller incisions, smaller surgeries: Video-assisted thoracic surgery

Available at numerous sites throughout the network

Surgeons perform this surgery by making small incisions in the chest and using a videoscope called a thoracoscope. They can more easily remove masses close to the outside edges of the lung and test them for cancer, requiring a much smaller surgery than in the past.

Removing masses more easily: Christopher Willms, M.D., Thoracic Surgery, Sentara Martha Jefferson Hospital

New options for a new look: Advanced breast reconstruction

Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara Obici Hospital, Sentara Princess Anne Hospital, Sentara RMH Medical Center

Many women choose reconstructive surgery following breast cancer surgery and treatment, and innovative procedures that use a woman’s own tissue are an option. Advanced microsurgery techniques, including the deep inferior epigastric artery perforator (DIEP) flap method, make it possible for surgeons to complete the reconstruction while also preserving patients’ abdominal muscle.

A quicker recovery: Transanal endoscopic microsurgery

Sentara CarePlex Hospital, Sentara Virginia Beach General Hospital

The minimally invasive transanal endoscopic microsurgery offers a quicker recovery, with less scarring and fewer complications. This surgical procedure uses a natural orifice to remove select rectal tumors that traditionally would require a more involved and invasive surgery.

Lobectomy Mortality*

Sentara Cancer Network vs. Society of Thoracic Surgeons (STS) National Database Benchmark

Sentara CarePlex Hospital, Sentara Leigh Hospital, Sentara Norfolk General Hospital, Sentara Obici Hospital, Sentara Virginia Beach General Hospital, Sentara Williamsburg Regional Medical Center

* Source: Society of Thoracic Surgeons database

Pancreatic Resection Mortality*

Sentara Cancer Network consistently meets or exceeds the data presented in the Journal of the National Cancer Institute.

Sentara CarePlex Hospital, Sentara Leigh Hospital, Sentara Norfolk General Hospital, Sentara Virginia Beach General Hospital

* Source: CareDiscovery database, Sentara Decision Support; Journal of the National Cancer Institute, Assessment of Pancreatic Cancer Care in the United States Based on Formally Developed Quality Indicators

Needle Biopsy Performed Prior to Surgical Treatment of Breast Cancer

Sentara exceeds the NAPBC goal of at least 80% of cases. Biopsying breast nodules to determine if they’re malignant prior to resection leads to reduced breast re-excision rates.