Apr 7, 2022 Breathe a Sigh of Relief

Many pulmonary conditions can be treated in ways other than open surgery. Two physicians at CBMC share how they use technologically advanced and minimally-invasive techniques to diagnose and treat disease and cancer of the lungs.

Lung disease is a serious condition, and knowing the warning signs can help you get treatment before it becomes life-threatening. But you can breathe easy knowing that there is excellent pulmonary care close to home that for many patients does not involve open-lung surgery. Since 2012, Cooperman Barnabas Medical Center (CBMC) has been part of the International Early Lung Cancer Action Program, a screening protocol that identifies lung cancer at an early stage in at-risk patients. Through this and other cutting-edge approaches, CBMC, in partnership with the Rutgers Cancer Institute of New Jersey (CINJ), is at the forefront in treating and diagnosing lung disease and lung cancer. Below are some of the conditions commonly seen by CBMC’s board-certified pulmonary medicine department, and the minimally-invasive and technologically-advanced ways through which they’re treated:

Lung Nodules

Nodules may be detected through the International Early Lung Cancer Action Program, but they’re also evaluated and diagnosed via incidental scans. “Some of these patients get scans done for other reasons such as CTs for cardiac disease or MRI of the breast, where the scan picks up an incidental spot in the lung,” says Kristin Fless, M.D., division director of pulmonary medicine and vice chair of medicine at Cooperman Barnabas Medical Center. “The great majority of these are benign, but they require evaluation and follow-up and shared decision making with the patients as to whether or not they need to be biopsied.”

Earlier this year, the hospital purchased an Auris Monarch robotic bronchoscopy platform, which helps pulmonologists and surgeons navigate and target lung nodules for diagnosis. “The Monarch system is good at accessing smaller lung nodules because the bronchoscope and the catheter that we feed through the camera down into the trachea are mounted into a static system [rather than handled by the surgeon],” says Joanna Sesti, M.D., thoracic surgeon at Cooperman Barnabas Medical Center. “This allows us to more precisely navigate through the lung tissue and maintain that position while we biopsy and treat the nodule.” This minimally-invasive procedure requires anesthesia, but it’s outpatient, results in no external scars and is an easier recovery than that of open lung surgery.

Emphysema and COPD

The pulmonary team at CBMC also uses a bronchoscope to treat most patients with emphysema, a disease typically caused by tobacco smoking, or chronic obstructive pulmonary disease (COPD). Emphysema can’t be cured, says Dr. Fless, but for some patients, it can be managed by endobronchial lung volume reduction. Previously, the abnormal part of the lung would have to be removed surgically to allow the normal lung to expand. “Now, we are able to implant a Zephyer device through bronchoscopy. This valve allows the abnormal areas to collapse to make room for the healthier lung,” says Dr. Fless. “We can achieve the same results without removing the lung or a making the patient undergo a larger procedure.”


Severe asthma cases are treated with an outpatient, minimally-invasive procedure also done through a bronchoscope called bronchial thermoplasty, Dr. Fless explains. This is a radiofrequency ablation of the airways that uses heat to smooth muscle to prevent it from tightening and causing asthma symptoms.

Minimally-Invasive Surgical Options

Bronchoscopy or other minimally-invasive methods are used to rule out or diagnose early stage lung cancer and sometimes to avoid open surgery. And for lung cancer patients who aren’t candidates for an open lung cancer resection, CyberKnife may be an option. “Using bronchoscopy, markers can be placed into the lung to act as specific targets for the radiation therapy. This targeted approach protects the normal lung tissue,” says Dr. Fless. From a surgical standpoint, another innovation employed at CBMC is the robotic-assisted da Vinci surgical system, which is used to perform lung biopsies, treat inflammatory conditions of the lung and cystic fibrosis, for which the pulmonologist requires a biopsy in order to target medications for treatment. The benefits, says Dr. Sesti, is this method requires fewer and smaller incisions than open surgery would. “There’s significantly decreased pain after robotic surgery too, and 95 percent of patients are out of the hospital in two days instead of four or five.”

Are You at Risk?

Though smoking increases the risk of lung cancer and emphysema (and typically present in older patients), not only smokers are susceptible to diseases and cancers of the lung. Even young people that have never smoked can develop lung cancer due to a genetic mutation, says Dr. Sesti. If you experience an unresolved cough, shortness of breath and/or have an abnormal chest X-ray that detects emphysema or a spot on the lung, don’t delay evaluation or treatment.

Learn more about pulmonary services at Cooperman Barnabas Medical Center.