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Carolyn Rothfeld was nearly finished with her morning two-mile walk when a sharp, fleeting jolt shot through her upper right abdomen—right where her chest tube had once been. The sensation, triggered by something as small as a cough or sneeze, lasted only a second. She calls them “nerve jolts.” Painless, but impossible to ignore.

Nine and a half months earlier, a routine CT scan in March 2024 had revealed a small nodule in her lung. A year later, another scan showed the nodule had grown to 10 millimeters and appeared more solid, with the hazy, less-defined appearance known as a ground-glass opacity. Her pulmonologist, Dr. Keith Brenner, walked her down the hall to meet Dr. Nabil Rizk, chief of thoracic surgery at John Theurer Cancer Center. On the way, her body turned ice-cold. “My body was suddenly reacting to the news,” Rothfeld said.

Robotic surgery and precision biopsies

Rizk performed a robotic video-assisted thoracoscopic surgery (VATS) segmentectomy, removing the cancerous portion of Rothfeld’s lung. Biopsies confirmed the adenocarcinoma was contained within the nodule and had not spread.

How do doctors biopsy lung masses? Dr. Geoffrey Pelz, a thoracic surgeon on Rizk’s team, explained there are three general ways. The first is a CT-guided biopsy, where the area is numbed from the outside, and a needle is guided in—useful for larger masses near the edge of the lung. The second approach uses ion robotic bronchoscopy, which builds a 3D reconstruction of the lung and its airways. “It’s kind of like a GPS for your car,” Pelz said. “I can say that this is the target I want to go to. It’ll draw me a little roadmap, and then we can follow that in the operating room and reach any part of the lung from the inside.”

The third option is to go straight to surgery—sometimes a limited wedge resection or another lung-sparing procedure. “I can give my opinion as to what I think is best for that patient, but ultimately it’s up to the patient and family to decide,” Pelz said.

Rizk’s team uses the ion bronchoscopy technology to inject a dye near the tumor before surgery. This helps locate tumors that are hard to see or feel. The process adds about five minutes to the procedure to give surgeons a visual guide once they’re operating with the robot, helping ensure a clean margin.

Recovery and the fear of surgery

In Rothfeld’s case, the lesion sat too deep for a simple wedge resection, so her team performed a segmentectomy instead, sparing two-thirds of that part of her lung while still removing the cancer. The decision about how much lung tissue to remove depends on the tumor’s location and size, Rizk said. Smaller masses near the edge of the lung can often be removed with a localized resection, along with a sample of nearby lymph nodes to check for spread. Larger tumors, those located deeper in the lung, or those that span multiple segments sometimes require a lobectomy—or, in rarer cases, removal of an entire lung.

Rothfeld’s recovery went better than expected. Nine months later, she has returned to the gym and walks almost daily. The nerve jolts are less frequent. “They don’t hurt,” she said. “They’re just reminders, and I know they’ll fade completely.”

She never questioned her decision. The surgery gave her more time—time she has spent with loved ones who supported her, even when their own lives were busy. “Whatever your personality, don’t isolate yourself,” she said. “You don’t have to face this alone.”

Rizk explained that most lung surgeries today are done robotically, in a minimally invasive fashion—a shift that has dramatically improved healing time and recovery. For Rothfeld, the procedure marked a new beginning. The occasional nerve jolts are a small trade-off for the chance to keep walking her daily two miles.