Pope arrives in hospital ahead of surgery to have lung nodule removed today

Pope Leo XIV was admitted to Rome's Gemelli hospital today ahead of surgery to remove a lung nodule, an operation that experts say will determine whether the lesion is malignant and if other treatment is needed.

After the quick drive from the Vatican, Leo walked into the hospital through the main entrance and waved to dozens of well-wishers who had gathered to greet him. 

The Vatican said the surgery would be performed later in the afternoon by a team led by Gemelli's chief thoracic surgeon, Dr. Stefano Margaritora.

The 71-year-old American pontiff has offered a rare level of transparency about the first publicly disclosed major health problem of his 17-month papacy. 

He revealed the discovery of the small, localized nodule during his Sunday noon prayer and announced that he would have it removed. 

Oncologists say even if the nodule turns out to be cancerous, Leo's prognosis is 'excellent' since it will have been removed at an early stage.

The surgery, which is usually performed under general anesthesia, will require a weeklong hospital stay and the Vatican on Monday canceled all Leo's audiences through to October 20.

'These are things that can be treated very well, if the words he used reflect the clinical situation,' said Dr Lorenzo Spaggiari, director of thoracic surgery at the European Institute of Oncology, or EIO, in Milan, who is not involved in the pope's care but knows the team at Gemelli.

A churchman who saw Leo on Monday, Tokyo Cardinal Kikuchi Tsutomu, said Leo told him he felt fine and decided to have the surgery immediately so that he wouldn't have to alter his upcoming travel plans to Latin America.

But the decision clearly came as a surprise. While Gemelli has a specific papal apartment that past popes have used, complete with a private chapel on the 10th floor, Leo will actually be staying in a nearby room since the papal apartment is currently undergoing renovations, according to the Vatican press office.

Dr Spaggiari said he expected the team at Gemelli would perform a biopsy to determine whether Leo has lung cancer followed by the removal of a section or lobe of the lung where the nodule is located.

Both could be done using robotic techniques, and could be performed consecutively, under the same anesthesia, with different specialist teams, Dr Spaggiari said.

A sophisticated robotic bronchoscopy technology called ION allows a biopsy on nodules as small as 3 millimeters (1/10 inch), Dr Spaggiari said. Both the Gemelli and the EIO have the technology, which has been available in Italy for just two years.

Gemelli also has robotic surgical technology, allowing the operation to remove the nodule to proceed 'using a minimally invasive technique,' he said.

The technique involves the surgeon making four small incisions in the chest through which the instruments of the so-called da Vinci robot are inserted, he said. 

The surgeon then controls the robotic arms looking at a screen providing high-definition, 3D views of the surgical site.

'It's a very well-established technology. This is something we have been doing for 20 years,' he said.

It wasn't known for certain what technique would be used on Leo. Gemelli has documented using both robotic procedures to diagnose and operate in under four hours.

The biopsy risk is 'virtually zero,' while the surgical risk is very small, carrying a 0.6 per cent to 0.8 per cent mortality rate for patients in otherwise good health with good heart and lung function, Dr Spaggiari said.

During the surgery to remove the nodule and part of the lung, doctors would also remove lymph nodes that drain the segment or lobe. 

'If all those lymph nodes turn out to be negative, so stage one, then the outlook is very good,' he said, adding that no other treatment would be necessary.

The nodule was discovered during regular checks, the Vatican has said, and Dr Spaggiari said the pope has likely undergone other tests before being recommended for surgery.

'I think he has had a bit of luck. They found something that was asymptomatic - a lung nodule, possibly a tumor. He might call it something else; we call it luck,' he said.

EIO advises patients not to fly for three weeks after surgery - which would give the Chicago-born pope just the interval needed to make his planned November 6 to November 17 trip to Uruguay, Argentina and Peru, depending on his recovery. 

The current itinerary for the trip is ambitious and the longest of his papacy to date, calling for Leo to clock just over 31,000 kilometers (19,000 miles) on a dozen flights and two helicopter rides, and a significant altitude change in Peru.

'I think the Holy Father is in excellent hands at Gemelli,' Dr Spaggiari said. 'They have everything needed to keep the Holy Father alive for a long time.'

Kikuchi, the Tokyo archbishop who is also head of the Vatican's charitable federation Caritas Internationalis, said Leo told him he felt no different than usual and was looking ahead to the trip.

'He has decided to undergo surgery soon in order to not change his plans for future overseas trips, so there is no need to worry, as it is not an emergency,' Kikuchi wrote on the Facebook page of the Tokyo archdiocese.

A lung nodule is a small abnormal area measuring less than 3 centimeters (1.2 inches) that sometimes appears on a CT scan of the chest or abdomen. 

Often, the scans are done to investigate trauma or a lung infection, unrelated to a lung cancer screening. 

A nodule can be benign or malignant, and oftentimes surgical removal is recommended both to establish whether it is cancer and to treat a malignancy while it is still localized.