Creating Positive Outcomes
Find hope for healing of thoracic and esophageal conditions here. Internationally recognized surgeon Farid Gharagozloo, MD, FACS, leads GRI's Thoracic Surgery Program at AdventHealth Celebration. Using the latest robotic-assisted technology and advanced treatments, his team is creating positive outcomes for lung, chest and esophageal disorders.
Benefits of Robotic-Assisted Thoracic Surgery
- Game-Changing Surgery
Medical robotic-assisted tools can greatly benefit the surgeon during your minimally invasive procedure. They provide greater access to the area needing surgery and more precise movement. Your surgeon can use smaller incisions and find greater visibility within the body. This can dramatically increase the positive outcome of your procedure. In addition to less blood loss and pain, the risk of infection is lower and usually results in a much shorter hospital stay.
- Experienced Team
One of the main factors to achieving success using minimally invasive, robotic-assisted techniques is the surgeon. Dr. Gharagozloo can achieve the many positive outcomes that occur using these procedures. He is recognized around the world as a pioneer and leading expert in the field.
Dr. Gharagozloo has performed over 1,000 robotic-assisted surgeries of the lung, esophagus and chest. Plus, he has published almost 200 peer-reviewed articles and is the senior editor of the highly regarded book in the field, Textbook of Robotic Surgery.
- Multidisciplinary Approach
The Thoracic Surgery Program works in in close partnership with experts throughout many medical specialties. These include such areas as pulmonology, gastroenterology, medical oncology, radiation oncology and other medical specialists. This multidisciplinary approach gives your medical team the ability to fully diagnose your thoracic condition and determine the best treatment for your needs.
- Support of a World-Class Health Care System
The mission of the AdventHealth Global Robotics Institute at AdventHealth Celebration is centered on you. Our goal is to provide a nurturing, healing environment that supports the best possible outcomes. We do this by emphasizing the whole person—mind, body and spirit. Our state-of-the-art campus and treatment programs are designed around these core principles. And, we provide the instruction and support programs you need to make informed healthcare decisions.
Thoracic diseases can vary widely. This means early diagnosis and treatment in a supportive environment is vital. It’s reassuring to know that when surgery becomes your best treatment option, our Thoracic Surgery Program has some of the most advanced doctors and medical robotics tools in the field.
- Thoracic Surgery Advantage
AdventHealth Celebration is home to the AdventHealth Global Robotics Institute. It is internationally recognized for its cutting-edge research and training in medical robotics. They are leading major advances in robotic-assisted surgery that continue to advance modern medicine.
Robotic-assisted surgery provides many benefits in the hands of the highly skilled specialists at the AdventHealth Global Robotics Institute, such as:
- Enhanced, high-definition imaging, magnification and binocular 3D vision for better viewing of intricate nerves, structures and incisions by surgeons
- Motion scaling technology with tremor filtration to eliminate tiny, uncontrolled movements in the surgeon’s hands for better precision
- Less invasive and safer than many traditional surgical procedures
- Reduced pain, blood loss and lower risk of infection
- Faster healing with shorter hospitalization
- Reduced interruption of the natural healing process versus open chest methods
- Much smaller incisions reduce scarring and trauma to the body
- Improved ergonomics enhances the natural movements of a skilled surgeon
- Body retains more of its pulmonary (breathing) functions for better oxygen intake to support quicker healing (Lung Surgeries)
To learn more or to schedule a consultation with our Oncology and Thoracic Surgery Program clinical care coordinator, call 407-303-4877.
Conditions and Treatments
Our Thoracic Surgery Program treats a range of conditions, diseases and cancers that affect the lungs and gastrointestinal system. It specializes in the most advanced treatments for Esophageal Disorders, Lung Disorders, and Nerve and Vascular Disorders:
- Achalasia and Esophageal Disorders
Achalasia and Esophageal Motor Disorders
The esophagus is the long tube that connects the throat to the stomach. Achalasia occurs when the muscle in the lower esophagus fails to relax. This results in difficulty swallowing, chest pain and vomiting. In most cases, medical therapy is not effective and the benefits of stretching of the esophagus (endoscopic dilation) are short-lived.
Laparoscopic myotomy is an approach that has been effective in over 90% of patients. The procedure cuts the muscle along the length of the front of the esophagus. Side effects, however, includes a possible increase in the incidence of reflux. When this occurs, a partial fundoplication may also be required. This is a procedure in which the upper stomach is wrapped around the esophagus.
However, adding the fundoplication is associated with significant complications. It can also decrease the long-term benefits of the myotomy itself. Dr. Gharagozloo has pioneered the Robotic Lateral Heller Myotomy technique—without the need for fundoplication.
Using this minimally invasive, robotic-assisted technique, the muscle of the esophagus is cut along the left side of the esophagus instead of the front. This approach preserves the normal gastroesophageal valve, preventing reflux and the need for a fundoplication.
The Robotic Lateral Heller Myotomy procedure without fundoplication is associated with a 98% benefit for patients, with no reflux. It has proven to be superior to all previous procedures.
- Esophageal Cancer
People diagnosed with GERD and Barrett’s esophagus, and even chronic heartburn sufferers, are at risk of developing esophageal cancer. Cancerous cells in the esophagus usually do not cause symptoms until an advanced stage. This means few cases are diagnosed in the very early stages.
It is extremely deadly due to its generally late-stage diagnosis. However, routine screenings of the entire esophagus can help catch and treat esophageal cancer early. Today’s technology and awareness campaigns can change that and help produce better patient outcomes.
The Most Common Esophageal Cancers
- Esophageal cancer, or adenocarcinoma, is mostly found near the stomach. It generally begins in the inner layers of tissue and muscle in the lower esophagus, growing outward. This is the most common type of esophageal cancer.
- Squamous cell carcinoma grow can grow anywhere in the esophagus. It occurs in the top layer of cells that line the esophagus.
The Thoracic Surgery Program has esophageal cancer therapies that can reduce patient risks, pain and recovery time. Using minimally invasive and advanced robotic-assisted procedures, we can offer the most advanced surgical treatments. And as research creates new procedures, AdventHealth Celebration will continue to offer you the best treatment options available.
Treating Esophageal Cancer
Robotic-assisted Esophageal Surgery
Surgery will most likely be recommended if esophageal cancer is detected. Depending on the stage of the disease and general health of the patient, robotic-assisted esophageal surgery can usually be performed. It will be used as part of a multidisciplinary approach to treating your cancer.
However, it also can be done as a preventive treatment. AdventHealth Celebration is one of few hospitals in the country to perform robotic-assisted gastroesophageal valvuloplasty for GERD. This can significantly reduce your risk for esophageal cancer.
Dr. Gharagozloo is the medical director of the Thoracic Surgery Program at AdventHealth Celebration. He is one of the world’s leading surgeons of the technique. He has been recognized for his innovative surgical approach and the better outcomes he continues to achieve for his patients.
- Failed GERD Surgery
Re-Operation for Failed GERD Surgery
Traditional GERD surgeries, in many instances, can fail after a few years. This can result in acid reflux re-occurence, difficulty swallowing or bloating. In these cases, removing the previous wrap and performing a gastroesophageal valvuloplasty is an option.
This has shown to provide the best results for relief of these symptoms and return to normal eating. However, it is very complex and requires a highly skilled surgeon in the procedure.
Dr. Gharagozloo has vast experience performing esophageal surgery. He is internationally recognized for re-operations for failed fundoplications. The Thoracic Surgery Program at AdventHealth Celebration offers a variety of surgical options including robotic-assisted procedures. These approaches have shown to produce the best and most lasting long-term results.
Gastroesophageal Reflux Disease (GERD)
Dr. Gharagozloo is one of the leading thoracic surgeons in the world treating GERD (gastroesophageal reflux disease). Using an innovative surgical approach that only a handful of surgeons in the world perform, he regularly provides improved outcomes for his patients.
Non-surgical therapies and minimally invasive, robotic-assisted solutions are helping people find relief from stomach and esophageal issues—with little pain and downtime. However, when over-the-counter antacids no longer provide relief, it may be time for a proper diagnosis and permanent solution. Your digestive issue may be the result of a hernia, that can lead to GERD, Barrett’s esophagus or esophageal cancer.
With a hiatal hernia, acid from the stomach can “reflux,” or travel up into the esophagus. This can cause severe heartburn or regurgitation. Over time, these stomach acids can damage your esophageal tissue. Barrett’s esophagus is an advanced stage of this condition.
Most people suffering from GERD don’t develop Barrett’s esophagus. However, those who do are at an increased risk for developing esophagitis — difficulty swallowing or chest pain — as well as esophageal cancer. When GERD can no longer be managed by lifestyle changes and/or medications, surgery may the most effective treatment option for GERD and prevention for other esophageal issues.
Diagnosing GERD and Digestive Health Issues
Early detection and managing the disease to help prevent serious problems from developing is important. There are a few main diagnostic techniques we use to best determine the condition or disease, such as:
- Endoscopy is particularly useful for investigating digestive disorders related to GERD and getting a tissue sample. A thin, flexible tube outfitted with fiber optics and surgical tools is inserted into the throat. It helps determine if there is scarring from acid reflux, plus if benign or malignant cells are present.
- Laparoscopy and thoracoscopy are also used as diagnostic tools. They are usually inserted into a small incision in the abdomen. Major advancements in the technology for these procedures now make it possible to perform both minor and complex surgeries using these methods.
Other digestive health diagnostic screening and treatment options may include:
- Chest X-ray
- CT or CAT scan
- Endoscopic ultrasound
- Upper GI series (barium swallow)
Treating Digestive Health Issues and GERD
Once you are examined and a proper diagnosis is made, your best treatment options are fully explained and discussed with you. The best treatment for you will depend on many factors. It can take into account such things as your age, physical condition, lifestyle and overall health. The care team at Thoracic Surgery Program at the AdventHealth Global Robotics Institute at AdventHealth Celebration specializes in the following techniques to treat a variety of digestive disorders, specifically GERD.
Surgical Options to Treat GERD
Gastroesophageal Valvuloplasty Surgery
Robotic-assisted gastroesophageal valvuloplasty recreates the normal anti-reflux barrier valve between the stomach and esophagus. The groundbreaking procedure continues to show great promise for severe GERD sufferers. The surgery is recommended as an alternative to chronic, life-long medical therapy. It has also shown to lower the risk of side effects found with more-traditional GERD surgeries. As little as three weeks following surgery, many patients report little to no acid reflux symptoms.
The minimally invasive procedure is performed through small incisions in the abdomen. The surgery usually takes approximately two-to-three hours and most patients return home the next day.
AdventHealth Celebration is one of few hospitals in the country to perform robotic-assisted gastroesophageal valvuloplasty for GERD. Dr. Gharagozloo is one of the leading surgeons worldwide performing this technique. He has been recognized for his innovative surgical approach and the improved outcomes he achieves for his patients.
Hyperhidrosis is characterized by excessive and unpredictable sweating. It can result in significant psychological and emotional social burden—especially when affecting the upper extremities and hands. This accounts for it being labeled as the “silent handicap.”
Hyperhidrosis is caused by overactivity of the central nervous system. Unfortunately, prescription medications, topical agents and Botox injections have not been shown to provide long-term relief. Endoscopic thoracic sympathectomy (ETS) surgery, however, has shown to provide lasting relief.
ETS partially removes the sympathetic nerve. This disrupts the flow of excessive sweating in the upper extremities and the hands. It has shown to provide relief of symptoms in majority of patients. However, it is also associated with the devastating complication of compensatory hyperhidrosis (excessive sweating in other parts of the body) in up to 80% of patients.
Selective ETS Surgery
Dr. Gharagozloo has pioneered the use of highly precise medical robotics for ETS surgery. Using minimally invasive, robotic-assisted systems provides the advantage of high-definition, magnified 3-D visualization. They are also minimally invasive and offer superior instrument maneuverability in confined spaces within the body.
This enables the surgeon to selectively cut the sympathetic nerves that go to the upper extremities. By better preserving the nerves that go to the other parts of the body, compensatory hyperhidrosis is lessened. Robotic-assisted selective endoscopic thoracic sympathectomy has been shown to relieve symptoms in 96% of patients—with compensatory sweating in only 7% of patients.
- Lung Cancer
A team approach is used at the AdventHealth Global Robotics Institute to treat lung (thoracic) cancer. World-renowned robotic surgeon, Farid Gharagozloo, MD FACS, and his team, works hand-in-hand with oncologists, radiation oncologists and other cancer specialists at Celebration. Together, these cancer experts help aggressively treat several types of lung cancer to achieve the best results possible.
Diagnosing Lung Cancer
Lung cancer is among the top three most common cancers diagnosed in the United States. The American Cancer Society estimates that 650,000 of all Stage I cancers, however, remain undiagnosed in America. This means most new cases of cancer are discovered in the late stages, which greatly impacts survival rates.
As with most cancers, early detection and prompt treatment is the best predictor of a successful outcome. Luckily, advancements in screening techniques have increased early detection and treatment for better survival rates.
Treating Early-Stage Lung Cancer
Robotic-assisted Lung Surgery
Lung cancer is classified in five stages of progression. Beginning with Stage 0 up to Stage II, robotic-assisted surgery is one of the best options to cure your lung disease. A broad approach will be used. This can include a combination of surgery to remove diseased tissue, along with chemotherapy and radiation therapy.
Some cancer tumors develop in areas that are difficult to access using traditional methods. Or, reaching them may demand large, highly invasive incisions that can be taxing on the body. Advances in robotic-assisted, minimally invasive lung surgery have helped address these challenges.
One of the most important criteria for success in robotic assisted surgery is the skill and experience of the surgeon. Dr. Gharagozloo and his expert Thoracic Surgery Program team are very skilled using these methods. Plus, robotic-assisted lung surgery can offer many advantages. They include smaller incisions, less pain and scarring and shorter recovery time.
Treating Late-Stage Lung Cancer
In later stages, the lung cancer has spread to nearby tissue or lymph nodes in other parts of the body. This requires a multidisciplinary approach to find the right treatment for your specific situation. We work directly with top oncologists, radiologists and pulmonary specialists to determine the best approach for you.
The most common cause of mesothelioma, or more precisely, malignant mesothelioma, is exposure to asbestos. Many uses of asbestos were banned throughout the 1970s in the United States. The National Institutes of Health estimates that between 1940 and 1978, 11 million people were exposed to asbestos. However, it can take 10 to 40-plus years for it to develop into cancer.
Today, as medical director of Thoracic Surgery at AdventHealth Celebration, Dr. Gharagozloo remains a leading expert in robotic-assisted mesothelioma surgery.
Many primary care doctors have difficulty identifying mesothelioma. The disease is rare and has non-specific symptoms. Each year, 2,000 to 3,000 new cases of mesothelioma are diagnosed in the United States. Most referrals to oncologists come after connecting it to a patient’s work history in a high-risk industry.
Traditional surgery to treat mesothelioma is very complex. To access and remove the diseased tissue, the lining of the chest must be carefully pulled away. This can cause significant blood loss during surgery.
Dr. Gharagozloo, MD, FACS, studied the traditional technique. He then designed a breakthrough, minimally invasive approach. In 2013, he performed the first two robotic-assisted surgeries for mesothelioma. The innovative procedure proved to be far safer and result in lower blood loss. It also dramatically improved healing time and quality of recovery. For these reasons, a minimally invasive approach to treating mesothelioma is favored.
- Thoracic Outlet Syndrome (TOS)
The thoracic outlet is located between the armpit and base of the neck. Bordering a passageway that travels through it is muscle, bone and tissue. Thoracic Outlet Syndrome (TOS) occurs when the packet of blood vessels and nerves that run through this path, from the chest to upper extremities, become pinched.
Medical director of Thoracic Surgery at AdventHealth Celebration, Farid Gharagozloo MD, FACS, has substantial experience and expertise treating TOS. He is widely recognized as one of the premiere thoracic surgeons in the country treating this disorder.
Patients can experience a range of symptoms. These can be from intermittent and mild—up to chronic pain in the neck, shoulder and arm. It can also include swelling, numbness and weakness in affected areas. In more serious cases, blood vessels can become very constricted and impair blood flow to the arm. This may lead to discoloration and pain extending down to the hand. If symptoms become severe, it can cause deadly blood clots.
Causes of TOS include an inherited defect that causes an abnormal first cervical rib extending from neck. However, it can also be caused by environmental factors. These include injuries, obesity, weightlifting, pregnancy and occupations that require constant arm to shoulder motion.
Whatever its cause, TOS can be very difficult to diagnose and treat. Historically, this “ghost pain” was treated using prescription medications and physical therapy. However, proper diagnosis can now be achieved through a magnetic resonance angiography (MRA) or a magnetic resonance venography (MRV). These non-invasive, painless medical tests provide clear images of blood or nerve blockage to help physicians diagnose and treat TOS.
When you are experiencing chronic pain and numbness, with little or no relief through other methods, surgery may be recommended. This is particularly true if you have a malformed first cervical rib.
This surgical area is usually difficult to reach using traditional methods. That’s why the AdventHealth Global Robotics Institute at AdventHealth Celebration offers a robotic-assisted approach. Using a minimally invasive procedure allows the surgeon to partially remove the first rib. This has been associated with a lower likelihood of neurovascular complications. Plus it can provide speedier recovery and healing, with less pain.