Lenox Hill Thoracic Surgery
National Leaders in Minimally Invasive Thoracic Surgery
Richard Lazzaro, MD FACS
Byron Patton, MD
Patient Stories

Bloodless Surgery

WHEN DOLORES F. 87, TOLD HER DAUGHTER Elba that she was having difficulty swallowing and keeping food down, “I knew I had to bring her to New York Methodist—‘My Methodist’ I call it,” she said. “I wouldn’t take her to any other hospital.” And it was a good thing she brought her to NYM’s Emergency Department when she did, because although she didn’t know it at the time, Mrs. F. not only had esophageal cancer, but endometrial cancer—cancer of the uterine lining—as well. From the Emergency Department, Mrs. F. was immediately admitted to the Hospital for surgery. Be- cause the cancerous blockage in her throat was making it difficult for her to eat, the esophageal surgery took priority over the endometrial cancer surgery. “Initially, there was concern about Mrs. Fuentes’s age and how her 87-year-old body would withstand two major surgeries over a relatively short time,” said Richard Lazzaro, M.D., chief of thoracic surgery at NYM, “but we assessed her cardiac and pulmonary functioning and she was in excellent shape!”

However, Mrs. F.'s age was not the only surgical challenge: due to her strict religious beliefs, she could not receive any blood or blood products during the procedure—a technique known as “bloodless surgery” would need to be utilized. “I have had five ankle surgeries and two total knee replacements at NYM, all bloodless” says daughter Elba. “I refer the Hospital to everyone in my community, not only because the quality of care is superior, but because the medical staff will respect my personal and spiritual beliefs.”

The Bloodless Surgery Program at NYM employs use of special medications, instruments, equipment, and procedures to minimize blood loss, and, using the latest technology, gives patients alternatives to blood transfusions. The medical records of patients in the Bloodless Surgery Program are carefully coded so that patients can feel confident that their requests will be honored. “Mrs. F’s esophageal surgery required an abdominal as well as thoracic approach,” said Dr. Lazzaro. “Using traditional, ‘open’ surgery, the potential for blood loss is significant. However, utilizing the minimally invasive daVinci robotic surgical system, I was able to more precisely perform the surgery under magnification and view the procedure three-dimensionally, which allowed me to perform the surgery with minimal blood loss and trauma,” says Dr. Lazzaro. Mrs Fuentes had an uneventful recovery and eight weeks after her successful—and bloodless—first surgery, Mrs. F was able to undergo surgery for endometrial cancer. “I needed to perform a total hysterectomy—removal of the uterus, ovaries and fallopian tubes,” says Constantine Gorelick, M.D., gynecologic oncologist at New York Methodist Hospital.

“After Mrs. F was fully recovered from her surgery with Dr. Lazzaro, I was also able to perform the hysterectomy using the daVinci robotic surgical system. Using the robotic surgical system for both the thoracic and the gynecologic cancers was ideal for Mrs. F: it is minimally invasive, which is less traumatic to the body, and also results in significantly less blood loss, which is important when following bloodless surgery techniques,” said Dr. Gorelick. “The key to success in these challenging cases involves a truly multidisciplinary, interdepartmental approach through all transitions—from preoperative assessment to the operating room, from the recovery room to home. It is that continuity of care that defines our Hospital,” says Dr. Lazzaro

“Once again,” Elba  says, “I am thankful for New York Methodist Hospital. Not only is my mother now cancer free, but everyone was so great when we were at the Hospital. They took such good care of my mother and they went out of their way to make sure that we were both comfortable and had everything we needed. They looked out for both of us.”

Lung Preserving Surgery

Sondra S smoked two packs a day for 40 of her 75 years. Smoking was part of who she was; she loved it and didn’t think twice about it. As with the other parts of her life-- raising her family, working as secretary to the psychologists in Brooklyn Family Court—she did nothing with half-measures. She smoked eagerly and often.

Until it was time to stop. Eighteen years ago, she knew it was the best thing for her health, so she put her mind to it and that was it. A 40-year habit was history—in one sense. Although the habit was gone, her body still bore the effects of all that smoking. Her doctor, Harry Berkowitz, M.D., told her that she would need to get yearly chest x-rays, just to keep an eye open out? for any changes in her lung tissue. Each year, she got a clean bill of health. The first 16 or 17 of these x-rays pretty routine. But the 18th was anything but.

“After 17 years of clean examinations, what I had been quietly dreading all of those years finally showed up: abnormalities on my x-ray,” Ms. S remembers. “I went for more detailed scans, and the results pointed to my worst nightmare: cancer. I needed surgery as soon as possible. I was referred to Richard Lazarro, M.D., chief of thoracic surgery at NYM.”

“I admit, I was scared. I was broadsided by my diagnosis and nervous about working with a surgeon I didn’t know. I was talking with a group of friends about lay ahead for me and the decisions therein and one women stopped me as I spoke: ‘Dr. Lazzaro? I want to tell you that he is the most wonderful man. You have absolutely nothing to worry about!’ Hearing one of my trusted friends sing his praises was all I needed. I called and made my appointment to see him.”

”During our first meeting we did a lot of talking, and he did a lot of listening. I was in a lot of mental anguish and I felt that he listened to me and had my entire well being at heart,” Ms. S. recalls.

“When I first meet with patients, they don’t usually have big smiles on their faces—they are in an anxious place and filled with the uncertainties of how the cancer, and the treatments, are going to affect their lives. Part of my job as their surgeon is to support and counsel them through their treatment, to help them feel hope,” says Dr. Lazzaro.

“We were able to catch Ms. S’s cancer, an adenocarcinoma, in the early stages: The cancer had not seeped into the surrounding tissue nor spread to the lymph nodes. The localized nature of her cancer, coupled with her diminished lung capacity after decades of smoking (she was at 62 percent of normal), made what we call a ‘wedge-ectomy’ the obvious surgical choice,” says Dr. Lazzaro. “In a wedge-ectomy, a pie-piece shaped section of the affected lung is removed rather than half of the lung, which is more customary, thus minimizing further compromise of breathing function

“After the surgery, we needed to discuss next steps and determine if further oncologic treatment was necessary,” says Dr. Lazarro. Hani Ashamalla, M.D., chief of radiation oncology, David Dosik, M.D. chief of hemotolgy/oncology, and Dr. Lazzaro all reviewed Ms. S’s case, and, she says “they determined that at this stage, I need no further treatment. It made me feel so comfortable and secure that these doctors came together as a team to determine the best course of care for me. Each doctor was consistently so kind to me; they never treated me as if I was ill.”

“Dr. Lazzaro’s office scheduled my appointments and tests for me, coordinated my care, and helped shepherd me through my treatment. I had enough on my plate to contend with; knowing that his team was there, supporting me made such a difference. And he was so attentive! I was in the hospital for only two days and he must have come to see me one hundred times. Every time I opened my eyes, there he was!”

“It wasn’t until after the surgery that I was able to realize how compromised my breathing ability had become. I was often so short of breath and could barely walk short distances without a break. Now, I can walk much farther without a thought. I am very involved in the Jewish Association Serving the Aged, and have a lot more energy during our activities. My Mah Jong and canasta games have even improved!

“Although Dr. Lazzaro was able to remove all of the cancer, I will continue to need check ups just in case any new cancers ever appear. But should that ever happen, I know exactly where I will go for my treatment: New York Methodist Hospital. I really felt that I was supported all the way from my initial diagnosis through my treatment and surgery.”