The 72-year-old man lying on the operating table is in a deep slumber, anesthetist Dr. Walla Yousef keeping a close eye on the beeping monitors at his head.

The man was recently diagnosed with a GIST (gastrointestinal stromal tumour), a rare cancer of the digestive tract. Today, however, he’s in Operating Room #9 at Surrey Memorial Hospital because a scan has shown a new-found lesion on his right lung. It measures just under two centimetres and doctors need to take a sample of the tumour to determine if it, too, is cancerous.

In the past, the procedure would have required doctors open the patient and spread the ribs in order to access the lungs. But at Surrey Memorial Hospital (SMH), equipped with the latest technology, that won’t be necessary.

Instead, the plan is to do the procedure laparoscopically, using only small incisions and a tiny fibre-optic camera to locate the tumour in the lung tissue, bring it to the surface and cut away a sample of it for testing.

Dr. Ong, the man’s surgeon on this unseasonably warm fall morning, says it will be like finding a marble in a sponge.

Ong is one of three thoracic surgeons at SMH. She, Dr. James Bond and Dr. Ahmad Ashrafi share surgery time, each assigned a day apiece, and rotating a fourth day between them.

The trio sees nearly 600 cases each year at Surrey Memorial, one of just four thoracic surgery centres in B.C. While fewer than a quarter of the hospital’s thoracic surgeries are emergencies – things such as collapsed lungs or internal trauma resulting from a car accident or other injury – the bulk are elective procedures, such as tumour removal or hiatus hernia repairs.

Ong has worked in Surrey for two years since coming from Vancouver General Hospital.

• • •

The unconscious patient is rolled onto his left side, the red felt pen marks on his upper right chest clearly indicating which side is to be worked on. A scar runs the length of his belly, evidence of a past surgery.

A silver foil “lower body blanket” covers the patient from the waist down, and his calves also have pressurized cuffs to ensure proper circulation during the surgery.

A dozen people are in the operating room for the 72-year-old’s procedure, including doctors, nurses and a few medical students who are observing.

Before beginning, Ong takes a quick time out to outline what the procedure will be for everyone present and allows any questions and concerns to be aired. It’s a process called Crew Resource Management borrowed from the aviation industry to improve communication.

“Okay, let’s rock and roll,” says Ong.

A mask and cap covering all but her eyes and forehead, Ong scrubs her hands and arms with soap and water outside the OR. She then re-enters the swinging door, careful not to touch anything until handed a sterile towel with which to dry off. A blue gown is held up and she inserts her arms and a nurse ties it securely around her waist. Another nurse provides gloves.

• • •

Assisted by general surgery resident Dr. John Boutros, the petite Ong steps onto a stool and makes separate incisions through which the rod-like five-millimetre camera and surgical tools will be inserted. A faint burning smell is detected as the flesh is cut and cauterized simultaneously.

Once the camera is in, three TV monitors provide a clear view of everything in the man’s chest cavity. It’s all part of the VATS (video-assisted thoracic surgery) system Surrey Memorial prides itself in.

The doctors move the camera, carefully scrutinizing the screen to locate the tumour in the pink and grey mass that is the patient’s right lung.

“Let’s see if we can find this lesion,” Ong says.

Finally, she puts her finger through the incision to see if she can feel the growth.

Shortly after 9 a.m., the surgeon finds it. She then allows Dr. Boutros to do the same and they prepare to remove it – and what they hope is a sufficient amount of surrounding tissue – to be tested.

A contraption that both cuts and staples – ensuring the remaining lung is closed and repaired – is aligned alongside the tumour and a portion of the lung is removed. The piece, which is approximately five by three inches, is put in a drawstring-like plastic bag while still inside the chest and then pulled from the body and placed in a container.

• • •

A pathologist is called, who promptly comes to the operating room and whisks away the sample for immediate testing. He brings it to a lab where several samples are instantly frozen and then examined under a microscope. Immediately, he can determine if the surgeons have indeed removed all of the tumour and whether it is malignant or benign.

The good news is the surgeons have done a good job removing it. The bad news is the lump is malignant. Further tests will indicate whether it is a new cancer or has spread from the patient’s prior cancer.

“Between 80 and 85 per cent of my cases involve cancer,” Ong says.

Indeed, she has two more surgical procedures remaining in her day. And both are cancer-related.

Thoracic surgery:

• SMH is one of four centres in the province for thoracic (chest cavity, excluding the heart) surgeries in the Fraser Health region.

• Three thoracic surgeons at SMH take part in about 600 cases

annually.

• 15 to 20 per cent of thoracic surgeries performed at SMH are a result of emergencies such as internal trauma or collapsed lungs.

• 80 to 85 per cent of thoracic surgeries are elective, such as repairing hiatus hernias.

• Lung and esophegeal cancer are major components of

thoracic surgical practice.

• Lung cancer is the most common cause of cancer deaths among both men and women.

• The total number of lung cancer deaths totals more than the four next most common cancers combined (colorectal, breast, prostate and pancreas).

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