What is the A-PLUS Surgery Program?

The A-PLUS Surgery Program is available to patients with a high-risk lung nodule with concerns for lung cancer. If results of a biopsy show that the nodule is cancerous, the surgeons do procedures to diagnose and treat the cancer. Diagnosis and treatment occur at the same time in under a few hours. We safely discharge patients on the same day. For other procedures, patients have to stay in the hospital for days.

How does the A-PLUS Surgery Program work?

First, you will need a screening test for lung cancer. Your primary care clinician will order this for you. The screening test is done using a low-dose computerized tomography (LDCT) scan of the lungs. If the findings show there is a risk for lung cancer, we will direct you to a lung nodule clinic at Northwestern Medicine. There, a surgeon and pulmonologist will review your scan. If they agree that your results are concerning, we will offer you the A-PLUS procedure within a week. You will meet with an interventional pulmonologist and thoracic surgeon in the operating room. You will also learn about the newest technology.

The procedure starts with a robot-assisted bronchoscopy with live image guidance. This lets the team create a GPS-based roadmap of the lung. This guides them straight to the tumor. While you are asleep, the interventional pulmonologist uses the robotic scope to enter through your windpipe. They weave the scope all the way through the dense forest of the lungs into the tiny airways at the edges. This is where early cancers tend to form. Then, the interventional pulmonologist removes a small amount of tissue. They send the sample to an onsite lab for evaluation right away.

• If it is benign (non-cancerous), you will be discharged.
• If it is cancerous, the pulmonologist will inject an inert dye into the nodule. This leaves a dye mark for the surgery. Then, while you are still asleep, you will have a second procedure to remove that nodule.

The second robot has many arms, including a camera and other instruments. It allows surgeons to enter the chest cavity through tiny incisions using its 8-millimeter fingers. This lets the surgeon see the whole lung, identify where the dye marking is and remove just the cancerous segment. They do the surgery without cutting through any bone or muscle.