This month has proven to be an incredibly busy one for Munson Medical Center, seeing both record-breaking hospital traffic and a stabbing event that generated national headlines. Amidst all the chaos of July, though, the hospital quietly hit a major milestone: its first-ever “single-anesthetic event” for lung cancer treatment.

Munson surgeons were able to perform a cancer biopsy and then surgically remove the cancerous tissue just a few hours later, all while the patient was asleep under a single sedation. Hospital leaders say the achievement marks a new level-up for cancer treatment in Traverse City, with the potential to save more lives – and do it in a more convenient, less invasive fashion.

The surgery was performed as part of Munson’s Ion program, an element of the Cowell Family Cancer Center that launched last year with the acquisition of an Ion Robotic Surgical Assistant. That system enables minimally-invasive detection and treatment of lung cancer, often at earlier stages than alternative methods. In May, the Cowell team recorded their 100th procedure on the Ion.

While surgeons can use the Ion robot for both cancer detection and removal, those procedures are usually performed separately – days, weeks, or even months apart. While splitting up the procedures is often necessary for medical or logistical reasons, two of Munson’s Ion program surgeons – Dr. Melanie Holtrop and Dr. Brandon Wojcik – say the wait time isn’t ideal for the patient.

“We know that, when people have lung cancer, once that cancer is diagnosed, if it takes longer than 30 days to get them treated, mortality goes up and survival goes down,” Holtrop tells The Ticker. “So, there is always a push to try to get them treated as quickly as possible.”

On July 10, the Ion team had the opportunity “to get that interval down to essentially zero.”

“We were able to do our very first single-anesthetic event,” Holtrop says. “We had a patient who had high probability of having lung cancer. We did the biopsy via the Ion that morning; I think we got a cancer diagnosis at about 9am. And then, under the same anesthetic event, we flipped the room over and did the surgery. I did the biopsy, then stepped back; Dr. Wojcik took over, and he surgically removed the cancer.”

“Between the diagnosis and the surgery, I think we were done by about 12:30pm,” Wojcik adds, “The patient went home the very next day, and they are doing great. This was our first case like that, and we're really proud of it.”

Not surprisingly, the case required significant pre-planning, both to set the table for the baton pass between Holtrop, the Cowell pathology team, and Wojcik, and to brief the patient and family on potential outcomes. Because the patient remained unconscious between the biopsy/diagnosis and the surgery, there wasn’t an opportunity for the doctors to confer with the patient in between.

“The patient and I probably talked about 4-5 different possibilities, including what we could find in the biopsy that would cause us to proceed directly to surgery; and then, even within surgery, what type of procedure we might perform,” Wojcik says. “Sometimes, we can do a surgery that spares the healthy lung tissue. Sometimes, we have to do a lobectomy. So, we had to talk through all those potential outcomes with the patient.”

“When the patient woke up, they didn’t know what all had been done, so that was a cool discussion to have afterward,” Wojcik adds. “We could tell them, ‘Yep, we were able to do a lung-sparing surgery, and we took care of everything.’ And the response was just disbelief: ‘Wow, literally a week ago, you guys called me telling me I likely had lung cancer, and now I’m walking out cancer-free.’”

While Holtrop says the milestone “really has the potential to benefit patients,” she also cautions that not every lung cancer patient will be a candidate “for this type of same-day procedure.”

“It depends a little bit on how localized their cancer is,” Holtrop explains. “They need to be someone who we know probably has a cancer, but that the cancer on their non-invasive staging workup shows that they don't have any spread of disease, so that they would be a good candidate for surgical resection.”

Wojcik is hopeful the growth of the Ion program at Munson will just mean that more local lung cancer patients meet the above description.

“Since getting the Ion robot a year ago, we’ve been workling to establish a really great lung nodule referral program for providers all throughout northern Michigan,” Wojcik says. “Patients that are smokers qualify for lung cancer screenings, and more and more patients are having that done, which is good because it allows us to detect lung cancer before it's gone to lymph nodes or spread elsewhere. But even once the cancer is detected, you have to go through a series of biopsy workups, and for primary care providers, it’s just a lot of coordination with people they don't talk to on a regular basis. With this new lung nodule referral program, providers can basically just send us the patient, and we'll coordinate everything.”

The goal, Wojcik says, is to speed up the detection-to-treatment timeline for lung cancer patients, which could lead to single-anesthetic cases becoming more standard.

“Irrespective of cancer-based outcomes, there’s pretty good data to show that the period of time between diagnosis and treatment is very, very anxiety-fraught for patients,” Holtrop says. “So, even for that reason alone, the shorter you can make the wait, the better. “

“I always tell my patients, ‘I don't want you sitting there with cancer. I would want it out as soon as possible,’” Wojcik adds.

Pictured: The Ion team, following their 100th procedure in May. Back Row: Melanie Holtrop, MD, Pulmonary Critical Care (left), Brandon Wojcik, MD, Cardiothoracic Surgery (right); Front Row: Shelly Lall, MD, Cardiothoracic Surgery (left); Shiloh Tackett, MD, Pulmonary Critical Care (right)