Robotic Surgery of the Esophagus and Stomach
Why is it innovative?
Surgery to treat issues in the esophagus and stomach (known collectively as the "foregut") can be complex and requires the expertise of experienced surgeons. Conventional open surgery involves a large incision in the chest or abdomen, can be difficult to use to access certain areas of the foregut, and results in a prolonged recovery. Minimally invasive laparoscopic techniques have improved patients' quality of life by enabling surgeons to operate through smaller incisions, but laparoscopic tools can be rigid.
The latest minimally invasive robotic surgery techniques further refine foregut surgery. Compared with other approaches, robotic surgery is more exact, due to a greater range of motion and stability and a magnified view of the surgical field (the area being operated on). At NewYork-Presbyterian, our surgeons are national leaders in the use of robotic surgery to treat foregut disorders such as gastroesophageal reflux disease (GERD), achalasia (a swallowing disorder), and stomach cancers.
How you benefit
People who have robotic foregut surgery may benefit from:
- Small incisions with minimized scarring
- Better incision closure and stapling due to the steadiness of the robotic system and advances in instrumentation
- Less pain and discomfort after surgery
- Lower rate of postsurgical complications
- Ability to go home the same day or have a shorter hospital stay
- A quick recovery and return to normal activities
How does it work?
It's important to note that the robot does not perform the surgery; rather, the robotic system is a tool the surgeon uses to complete the operation. The surgical robot's arms are positioned where needed in the patient's abdomen. The surgeon sits comfortably at the robotic surgery console and is able to control the system's instruments from there. At NewYork-Presbyterian, digestive surgeons sometimes use a hybrid approach, performing robotic surgery in concert with interventional endoscopists who insert their tools through the patient's mouth and into the foregut.
- Robotic anti-reflux surgery for GERD. During a procedure called "fundoplication," the surgeon supports the weakened lower esophageal sphincter (the valve between the esophagus and stomach) by fully or partially wrapping the top portion of the stomach around the lower esophagus as a "bolster." This allows the sphincter to close, eliminating acid backflow from the stomach. We use combined endoscopy and robotic surgery to treat hiatal hernia, where part of the stomach bulges into the chest cavity through an opening in the diaphragm. "Hill" fundoplication is a technique that does not require an actual wrap, but enhances the muscle fibers of the stomach to support the sphincter. At NewYork-Presbyterian, we have some of the most experienced surgeons in the world performing the full range of robotic fundoplication procedures, tailored to the needs of each patient.
- Robotic achalasia surgery. A procedure called Heller myotomy can decrease the pressure of the lower esophageal sphincter and make it easier to swallow. The surgeon releases the muscles around the sphincter, relaxing this valve and allowing food to pass into the stomach more easily. To prevent reflux after the procedure, the surgeon typically performs a partial wrap of the stomach around the esophagus.
- Robotic gastrectomy. Removal of part or all of the stomach is a treatment for patients with operable gastric cancer. With robotic gastrectomy, the surgeon can remove certain stomach tumors — such as gastrointestinal stromal tumors (GIST) — without taking out too much of the stomach wall, as well as perform more accurate removal of abdominal lymph nodes to be analyzed for cancer cells. Our surgeons work with oncologists to offer clinical trials assessing minimally invasive robotic gastrectomy for gastric cancer, with the goal of enhancing recovery without compromising outcomes. NewYork-Presbyterian's surgeons perform the most robotic gastrectomy procedures in New York City. Patients can go home after as few as two days in the hospital.
Is it for me?
Your surgeon will let you know if you are a candidate for robotic foregut surgery.
- GERD. Robotic surgery may be an option for people with GERD who cannot obtain relief from anti-reflux medications, which are not meant to be used long-term. Surgery is most effective for patients whose GERD is caused by a defective lower esophageal sphincter.
- Stomach cancer. Robotic surgery may be an option for people with stomach tumors that can be surgically removed using minimally invasive means. NewYork-Presbyterian surgeons also have one of the world’s largest experiences performing prophylactic total gastrectomy for patients susceptible to a hereditary form of gastric cancer ("HDGC syndrome"). Our doctors have led advances in the removal of gastric tumors through the mouth, using either completely endoscopic procedures or combined endoscopy and surgery.
What does the future hold?
- Surgeons hope to be able to offer robotic foregut surgery using a system that enables them to perform the operation entirely through the patient's mouth, resulting in no external incisions.