New Program Offers Minimally Invasive Robotic Surgery for Patients with Gastric Cancer

Massachusetts General Hospital is expanding patient access to opportunities for minimally invasive procedures targeting gastric cancers. The new program led by Sophia McKinley, MD, MEd, a surgical oncologist in the Division of Gastrointestinal and Oncologic Surgery, will offer robotic gastrectomy as an alternative to traditional laparoscopic techniques or open surgery.

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"Robotic surgery has consistently demonstrated excellent outcomes as a minimally invasive intervention for different cancers," says Dr. McKinley. "I am excited to add this technique to the portfolio of treatment options available to gastric cancer patients at the Mass General Cancer Center."

Enhancing the Precision of Laparoscopic Surgery

Laparoscopic techniques offer a minimally invasive option to open surgery by allowing surgeons to operate using specialized instruments inserted through small incisions. These instruments include a single-lens camera (laparoscope) and a light source that together offer a magnified view of internal anatomy, enabling increased surgical accuracy.

Advantages of laparoscopic surgery include:

• Less postoperative pain due to smaller incisions
• Decreased risk of infection
• Reduced blood loss and fewer complications
• Quicker recovery and less time in the hospital

The advent of robot-assisted laparoscopic procedures introduced numerous advances in surgeons' ability to perform increasingly complex operations. The robotic instruments include multi-jointed arms that are manipulated by a surgeon using hand and foot controls. The enhanced dexterity and range of motion closely mimic hand, wrist, and arm movements used in open surgery but are lacking in traditional laparoscopic procedures.

Multi-lens cameras also provide depth, resulting in three-dimensional magnification of areas being operated on. Recent advances even offer correction of involuntary movement by either the patient or surgeon, resulting in the widespread adoption of robots for increasingly complex procedures.

The rapidly growing number of gastrointestinal procedures being undertaken using robot-assisted techniques is partly due to a shallow learning curve.

"The significant leap forward in visualization and instrumentation allows surgeons to more readily achieve technical competence," says Dr. McKinley.

These advances promote an almost seamless transition between traditional open or laparoscopic procedures and those involving robots.

Employing Robotic Surgery for Gastric Cancer

Surgeons' ability to quickly adopt this technology translates to expanded opportunities for patients requiring surgeries with higher degrees of precision. These include oncology procedures, such as pancreatectomies, colon or liver resections, and gastrectomy.

Dr. McKinley specializes in robotic gastrectomy to remove gastric tumors or address cancer-related complications in the digestive tract. Depending on tumor size and location, these operations can range from excision of small portions of the stomach wall to removal of the entire stomach and surrounding lymph nodes.

"The robot significantly enhances a surgeon's ability to safely and effectively perform highly complex operations such as these in a minimally invasive fashion," explains Dr. McKinley.

Specifically, access to magnified, multi-angle views of the areas being operated on cannot be achieved in either traditional laparoscopic or open surgery. For either partial or total gastrectomies, these advances allow the degree of precision necessary to ensure complete eradication of the cancer and restoration of digestive continuity.

"These platforms provide surgeons access to features that facilitate complete lymph node dissection and the creation of better connections between gastrointestinal structures," says Dr. McKinley. "This directly translates to improved outcomes for patients."

A Tool That Augments Surgical Skill and Training

An important caveat to using robots for minimally invasive surgery is that they are not replacing surgeons but instead providing a tool to optimize proficiency. Robotic procedures are performed by surgeons sitting in the operating room just a few feet away from the patient and who continue to be responsible for all decisions made during an operation.

Improved optics and instrumentation further translate to less strain on surgeons, and the ergonomic characteristics of the control console significantly contribute to reducing fatigue. In this regard, robotic platforms can augment surgeons' skills, endurance, and potential longevity.

This technology also serves as an excellent training platform. "During robotic operations, medical students, residents, and fellows can follow along as I narrate exactly what I am seeing and doing," says Dr. McKinley.

This degree of descriptive detail offers a more comprehensive experience and is highly effective at teaching the nuances of surgical oncology. "Recording surgeries also allows me to review what went well, identify ways to improve, and extend that education to others."

Dr. McKinley notes that despite its advantages, robotic surgery is not always the right choice. "The suitability of any procedure is patient-specific, and determining eligibility for minimally invasive techniques requires an appreciation of the complexity of the condition."

Different factors, including tumor size and location and the presence of other metastatic lesions, can recommend against certain methods, even those that are technically more precise.

In such situations, familiarity with all types of procedures enhances a surgeon's ability to determine and successfully perform the best approach. Dr. McKinley emphasizes the benefits of exposure to various interventions for different gastrointestinal cancers. As another tool available to surgeons, robots are sometimes the best option and sometimes not. In these cases, recognizing the best course of action is critical.

"When counseling patients about choosing a surgeon, my recommendation is to prioritize those having experience with all of the tools at their disposal," she says. "This increases the likelihood of the patient receiving the best care possible."

Opening a New Chapter in Surgical Oncology at Mass General

Dr. McKinley acknowledges the benefits of starting a robotic gastrectomy program at a world-class institution and one that has already proactively incorporated robotic surgery in other clinical areas. After completing the general surgery residency at Mass General, she was subsequently recruited during her surgical oncology fellowship to return for this specific purpose.

"I remember feeling lucky to train here as a resident and then later realizing as a fellow how well that experience prepared me to care for cancer patients," says Dr. McKinley.

The opportunity to learn something new during the fellowship and bring that skill set back to Mass General represents both a homecoming and a chance to return the favor. "It is an enormous privilege to be a part of Mass General and a responsibility that I take very seriously."

Part of this responsibility includes training the next generation of surgical oncologists as associate director of the Surgical Education Research Group in the Department of Surgery. A particular focus involves creating a training program that allows residents and fellows to attain competency in minimally invasive robotic surgery. The aim is to continue expanding access to these procedures for cancer patients by capitalizing on the talent and resources present at Mass General.

"The people here have a work ethic and commitment to patients that I know from experience is second to none," says Dr. McKinley. "The message that I convey to every cancer patient that I meet with is one of complete confidence that they are going to receive the best care available in the world."

Learn more about Gastrointestinal & Oncologic Surgery

Learn more about Mass General Cancer Center