Robotic surgery ensures kidney cancer patient can continue with his cycling tour of Croatia

 

In the summer of 2025, Dave Lucas was out biking with friends in the Skagit Valley when he hit a seam in the pavement at 20 miles an hour. He landed on the pavement with broken ribs, deflated lungs, a separated shoulder and a concussion, among other injuries. 

What he didn’t expect was a diagnosis of kidney cancer. 

A CT scan after the accident revealed a tumor on his right kidney. Within days, he was consulting with Yaw Nyame, MD, MS, a kidney cancer specialist at Fred Hutch Cancer Center.  

One of the first things Lucas told Nyame was that he and his wife had planned a bike trip around Croatia that was fast approaching.  

“It’s almost as if the stars aligned because before I met him, I thought to myself, this might be one of those cases that's amenable to a robotic approach, something that we’d been planning for,” said Nyame. "Dave seemed to be the perfect patient with regard to motivation to be willing to have us try that approach so that he could have that benefit of a faster recovery.” 

In this episode, Nyame and Lucas discuss the robotic surgical approach that enabled Lucas to carry on with his vacation plans and the value of customizing cancer care to meet a patient’s goals. The full transcript is below. 

Key takeaways:

• Dave Lucas learned he had kidney cancer after an unrelated CT scan revealed a tumor.
• Lucas came to Fred Hutch from his home in Anacortes, Wash. to see Yaw Nyame, MD, MS, in the Multispecialty Kidney Cancer Clinic. 
• The tumor in his right kidney extended into the vena cava, the largest vein in the body.
• It was advanced cancer but the tumor was not that large, making Lucas a candidate for an innovative approach.
• Nyame removed the tumor using minimally invasive robotic techniques that allowed for quicker recovery.

Listen to the audio interview

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Tune in for more episodes of From Bench to Bedside and Beyond. And if you’re interested in being a guest, please reach out to brochman@fredhutch.org.

 

TRANSCRIPT:

Bonnie Rochman (00:05.319) 
Welcome to From Bench to Bedside and Beyond. Today we’re chatting with Dave Lucas and his doctor Yaw Nyame, a kidney cancer specialist at Fred Hutch Cancer Center who shares Dave’s passion for being active and was with Dave in spirit on his recent bike trek through Croatia. So I want to do something a bit unusual and start from the end rather than the beginning because I love this story that was shared. 

Dr. Nyame, you said you give all your patients your cell phone number for emergencies. So Dave had your cell and he used it, fortunately not for an emergency, but for something even better, to text you photos from his trip in Croatia.   

Yaw Nyame (00:53.831) 
He did, yeah. We had an agreement that at four weeks Dave could ride. And so right around three and a half weeks, I got the picture from Croatia and I thought, you know, he must be doing pretty well if he’s up in the mountains riding. So it was a real treat to get what was a really beautiful picture on my phone.   

Bonnie Rochman (01:15.506) 
That’s amazing. Okay, so now let’s walk it back a little bit. You saw Dave in the Multispecialty Kidney Cancer Clinic because he had a tumor in his kidney extending into his vena cava, which is the largest vein in the body. And that’s a pretty advanced stage cancer. And you had told me that what really stood out to you is that unlike most tumors that extend into the vena cava, his tumor in his kidney was not that large actually, which made you feel like he might be a candidate for something a little bit different than what you often do with kidney cancer patients.   

Yaw Nyame (02:07.295) 
Yeah, you know, one of the things that I think we pride ourselves on as a program is really customizing cancer care to the patient. And a lot of my patients will hear me say that we will support you in all the ways that you need to be supported, whether that’s socially, emotionally, in addition to the clinical and therapeutic interventions that we provide. You know, tumors that extend into the vena cava take all forms, shapes, and sizes.  

For our program, we tend to see really advanced cases. And so if it’s complex enough, that often lends itself to a bigger approach, which means a big abdominal incision, which just takes a longer time to recover from but allows us to do these complicated surgeries in a slightly safer manner.   

Bonnie Rochman (03:04.851) 
Okay, so you had mentioned to me that we have this really very robust robotics program here at Fred Hutch, but you had not yet approached a tumor like Dave’s robotically. What is the reason for that?   

Yaw Nyame (03:22.345) 
Yeah, we do take out some thromboses robotically that are extending into the vein that goes to the kidney. But once you start having extension of a tumor into the vena cava, there’s, you know, it’s kind of, I always joke, we’re plumbers, right? There’s just more water supplies that need to be shut off because this is kind of a main thoroughfare of blood flow. And so it just makes that turnoff-of-blood process more complicated. 

So if it’s not extending too far into the venous system of the kidney, if you will, then there are maneuvers we can do to get enough room that we can safely divide using usually a stapling device to remove that thrombus. But once it gets into the vena cava, then we have to be able to essentially clamp three different points in the vena cava off completely so that there is no blood flowing into our vena cava when we open it because we’ve got to make an incision in it.

And traditionally we’ve done that with an open approach, and there are some advantages to open surgery especially if we need to do a lot of sewing or fixing of things. But again, I think a strength of our program is we’re not a one-size-fits-all program.  

Standing in clinic looking at Dave, he barely sat down. It was clear he was very active. And one of the first things he really mentioned was that he and his wife had planned a bike trip that meant a lot to them. It was clear that being able to make it to that trip would be meaningful to him. It’s almost as if the stars aligned.

Because before I met him, I thought to myself, this might be one of those cases that’s amenable to a robotic approach, something that we’ve been planning for. And Dave seemed to be the perfect patient with regards to motivation to be willing to have us try that approach so that he could have that benefit of a faster recovery. 

Bonnie Rochman (05:35.933) 
So I also remember that you had mentioned to me that a goal of yours is really to meet patients where they are. And then lo and behold, here is this very fit guy. And one of the things he mentions is this bike trip to Croatia that he’s got coming up. So kind of when you say you felt like the stars aligned, it was like in that moment, you felt like his personal goals of surgery or how quickly he would want to recover from a surgery, what he wants to achieve in the very short term, would actually align with something much less invasive than what you historically had been doing with patients like him.

Yaw Nyame (06:18.206) 
And again, you know one of the things that occurred with Dave is I was very upfront — look Dave, there are two ways we can do this: One of them is the traditional way we approach this. It’s an incision through your six-pack muscles. It’s a longer recovery, but it’s the tried-and-true way that we’ve approached this. And there’s a robotic approach that I feel comfortable with for these reasons, that we would have a really good contingency plan for who would be around especially during some of the critical portions of that surgery just to make sure we were safe.  

I was very upfront that even though we hadn’t done it, this is a program that does a lot of robotic surgery and I myself do over 100 robotic surgeries a year and they’re all complex and all the different things that I do for other approaches, whether it be bladder cancer or prostate cancer or even other types of kidney cancer, are all applicable skills that would transfer over to his surgery.

So I think I didn’t come into the room — and I hope Dave corroborates this — I didn’t come into the room and say, you’re having a robotic surgery, but I wanted him to understand what the benefits of those two different approaches would be. And when he said, well, I’m trying to get to Croatia, it seemed like, okay, well, I think we're both seeing an opportunity to take this approach that I thought was safe.  

Ultimately, I said this to Dave, and this is a line that I stole from one of my partners, John Gore, but our goals as a program are always the same. One is patient safety. We want to do your operation as safely as possible. That's 1A. And 1B, right below it, is to do a good cancer operation to get him cancer-free. And that has remained the goal since the time we met in that multidisciplinary clinic.   

Bonnie Rochman (08:09.213) 
Okay, well that’s a perfect transition into getting your perspective, Dave. So we’ve already established that you’re a very active guy. You’re 71, you’re from Anacortes, and you’ve also had a couple of previous brushes with cancer. And then you had this bike accident earlier this year in the springtime that set you on a very different course from what you were expecting. So I was hoping you could tell us a little bit about that.   

Dave Lucas (08:20.504) 
Correct. Yeah, interesting summer. In June, I was out bike riding with friends in the Skagit Valley and I hit a seam in the pavement at about 20 miles an hour and I was suddenly on the ground. I was taken to Skagit Valley Hospital with broken ribs, deflated lung, separated shoulder, concussion, neck injury, you know, the usual stuff. 

And the next morning, I had a urologist come in and say, we ran a CT scan on you just to see if anything else was wrong. Did you know that you had a tumor in your right kidney? No, I did not. And then it’s like, OK, so what are my options here? And up there, they said, well, we’ve already sent in an urgent referral to Fred Hutch. Give them a call in a day or two and they will ... Actually, they said that Fred Hutch would call me, which they did and started the ball rolling. 

Bonnie Rochman (09:51.037) 
Okay, so I remember one thing when you and I had spoken, Dave, that you told me, you said you’re a very positive person and that your viewpoint on life is, okay, if something is my reality, then rather than get really down about it, rather your approach is, okay, what are my choices? How am I going to tackle this? What am I going to do about it? So very action-oriented and very optimistic. 

Dave Lucas (10:19.48) 
Correct, up in the hospital in Skagit, rather than thinking, how did this happen? Why didn’t it? It’s, okay, it is my new reality. Where do I need to go? Who are the best people to talk to? Once I met Dr. Nyame, then it was, what can we do? What’s the best way to do this? And one of the things I really enjoyed was the conversation, being able to talk about the two different options, pluses and minuses, and coming to an agreement that, well, in my case, I’m comfortable. Let’s do the robotics because it should be a shorter recovery. I can make my trip. And it all worked out.  

Bonnie Rochman (11:09.467) 
And you had also said that you really appreciated when you were in your appointment, Dr. Nyame kept stopping to check for, to make sure that you were understanding what he was saying. You appreciated his, just his manner, the way he wasn’t directive and saying, I think we should do this but presenting all the options. And then you both jointly decided that, yes, robotic surgery seems like the way to go. So did I summarize that correctly?  

Dave Lucas (11:47.054)
Correct. What I’ll add in there is from the moment Dr. Nyame walked in, he’s a very engaging person. He focused on me. At all times, there was the pausing and looking to make sure that I had a chance to engage back, that it wasn’t just a doctor talking to a patient. I still remember him pulling out a piece of paper and drawing a picture of my kidney and where the tumor was, how everything was set up, what he would do. And those sort of things gave me confidence that I’m in good hands.   

Bonnie Rochman (12:33.509) 
Okay, so you had the surgery, then I think there were two weeks of walking, two weeks where you were allowed to walk, another week on your stationary bike, then you got on your actual bike to get some miles in, you got two or three rides in, and then you left September 2nd, I believe it was, for Croatia and you started your ride with your wife. 

Dave Lucas (12:55.95) 
Correct.   

Bonnie Rochman (12:57.263) 
And you felt a little weak, you said, but really no pain, which is wild to think about that you just had surgery and you were not in pain. You were riding 25 to 30 miles a day, eight days of cycling in this trip, and you were feeling great. 

Dave Lucas (13:13.934) 
Correct. Yeah, I shouldn’t say I was amazed because it’s what I was hoping for and expecting, but it was really nice to have the warmup rides here in Skagit County. Spent 12 hours in a plane to get there and then a couple of days of walking around, getting used to time zones and then jumping on a bike and up and downhill. And by the way, Croatia’s beautiful.   

Yaw Nyame (13:51.762) 
Yeah, I mean, I will add, for us, one of the things that’s a real strength of our program is that we are very well equipped to take care of complex cancer patients. And what Dave had was a complex cancer problem. And it’s a lot of preparation. And for me, especially, I mean, it’s one thing to know what to do, which was the case, but the devil’s in the details. This is what I tell our trainees all the time, right? The devil’s in the details. And so it’s all the little things, right? If I'm gonna clamp this exactly, like what do I do at this step? And, you know, fortunately I’ve got a lot of close colleagues from my prior training in Cleveland and just friends across the country that I could tap into to say, okay, I know you’ve done this or you’ve done a few of these, these are my very specific questions. 

[There’s] a lot of preparation and maybe a little bit of less sleep the night before Dave, if I’m being honest, because it’s, you know, the new thing, right? You want to make sure not too much, not too much, but you want to get it right, right? Because we’re dealing with people, right? And that’s really important to me that we give you our best shot. But what was incredible for me was it was kind of the village that came together on the day of surgery. You’re asleep. 

Bonnie Rochman (14:53.075) 
But hopefully not too much. 

Yaw Nyame (15:16.349) 
But you know, one of my partners came in to check in and see how we were doing. You know, we have a transplant surgeon that we collaborate with in these thrombus cases frequently. You know, he actually took time from some personal obligations to just be there during the most critical time when we’re opening the vena cava and was there present. You know, at some point I looked up and some of our residents who were out of their other surgeries were in to support and peek and learn, and it felt like our whole program was coming together to make sure we were serving you. And the very next day, the next morning, our chief resident rounded on you and he texted and said, I think he can go home today, which just for context, never do we do a thrombus case and send someone home the day after surgery. 

With a traditional incision, you’re usually hanging out with us for a few days on the early side. So it was really fantastic to see it all come together and then to have you share those pictures of you riding up in the mountains with your wife, I think really was the cherry on top. So I wanted to add that as some context to how it all came together so beautifully and it’s been really a privilege to be part of the team that’s been supporting you, Dave, in this new chapter of your life, being a cancer survivor. Or as the advocates I work with would say, cancer thriver.   

Dave Lucas (16:54.71) 
I like it, I like it, I will keep that. 

Bonnie Rochman (16:58.451) 
I don’t know how to top that. I had a couple more questions, but I think that this is just a really beautiful, beautiful ending. I just wanted to reiterate, August 6 was your surgery, Dave, and September 8, you texted those photos to your doctor. That's just amazing and inspiring and I think Dr. Nyame, you said that Dave’s first question was: “When can I get on the bike again?”   

Yaw Nyame (17:36.509) 
Yeah, he was committed You know, you’re always nervous But I think at that two three week mark and I knew I said as long as you’re going light on the bike I don’t even know what that really means going light on the bike. But you know as long as you’re not straining and you’re just getting your heart rate up. I think yeah, it’s okay. So he followed all the instructions to the letter of the law, if you will, and you know time had kind of escaped me when I said, has it really been a month? That’s just kind of what's happened in my phase of life now with young kids and a busy surgical oncology practice. I said, “Dave, has it really been a month? It feels like it was just yesterday.” And sure enough, he had hit it right on the mark. So that was great.   

Bonnie Rochman (18:25.415) 
Well, thank you so much. I also just wanted to just point out, Dr. Nyame, on your bio on the Fred Hutch page, the bio that if people are looking for a doctor and they’re Googling and your profile comes up, you have this quote. I don’t even know if you remember saying this quote, but it intersects so closely with what you’ve been talking about today that I just wanted to read it. You said: “The greatest pleasure of my job is getting to know my patients, understanding what drives them, exchanging stories and learning about the impact of their disease. These personal details help me provide comprehensive individualized care.” 

And I read that and I’m like, Boom, this is exactly what happened in this case where you were willing, not only willing, but motivated to think, what kind of surgery, what kind of approach works best for this particular patient? 

Yaw Nyame (19:25.436) 
Thank you for sharing that with me. It’s been a while since I've seen that quote. 

Bonnie Rochman (19:28.115) 
I figured. Anything that you would like to add, Dave?   

Dave Lucas (19:34.606) 
I think one of the biggest things I took away from Fred Hutch writ large is how everybody there is very caring, very engaging, very focused on the person in front of them.   

In addition to being very good technicians and a wonderful surgeon, that interaction was comforting. That is what made me trust, know it was going to turn out well, it just lowered all of the little bits of worry that were there. I don’t know what kind of a box to put that in, but that was just really important to have to feel.   

Bonnie Rochman (20:33.331) 
Amazing. Well, thank you. Thanks so much to both of you. I'm going to stop recording now. 

Yaw Nyame (20:36.966) 
Thanks for sharing that, Dave.