It’s 7 a.m. and the surgical staff at Emory University Hospital is prepping a patient for a potentially life-saving procedure. As a surgical oncologist at the Winship Cancer Institute of Emory University, I am leading one of the two groups of specialists working together to remove a type of stomach tumor known as a gastrointestinal stromal tumor (GIST). This is a rare tumor with approximately 10,000 new cases diagnosed in the Unites States every year. If left untouched, the tumor could enlarge or metastasize, requiring more radical treatment.
Stomach tumors are usually removed using one of two common techniques: endoscopy, in which doctors enter through the patient’s mouth using a flexible tube outfitted with a miniature camera and lasso-like device; or surgery, in which surgeons use minimally-invasive laparoscopic techniques to insert tiny surgical instruments through small incisions in the abdomen.
For this particular case, Dr. Field Willingham, Director of Endoscopy in the Emory Division of Digestive Diseases, and I are performing a groundbreaking hybrid procedure using both laparoscopy and endoscopy simultaneously, which allows us to reach tumors located in difficult areas of the stomach. In many cases, this procedure leads to the complete and safe removal of the tumor with fewer complications and/or long-term problems for the patient.
During the actual procedure, I begin by using laparoscopic tools to push the tumor from the outer side of the stomach so the more easily Dr. Willingham can grab the bulge from inside the stomach using an endoscopic cutting loop. I am able to push the tumor into the lumen of the stomach and Dr. Willingham successfully removes the tumor using a surgical snare technique. Next, Dr. Willingham pushes the area of the stomach where we removed the tumor from towards me. That allows me to hold the wall of the stomach and cut away any remaining tumor cells that may have been left behind.
By 10 a.m., the keyhole-sized incisions in the patient’s abdomen are being stitched closed. This particular operation is a complete success! We have safely removed the malignancy, leaving the patient’s lifestyle and ability to eat intact.
Emory was one of the first medical centers in the country to use this hybrid technique. We work closely with our colleagues in Gastroenterology to remove these complex tumors without requiring the patient to go through invasive surgery or complete organ removal.
While developing and performing innovative procedures like this is made easier by advanced technology and surgical techniques, a key to overall success is the multi-disciplinary team approach. While it helps that Dr. Willingham and I are friends outside of the operating room, it is very important as colleagues that we communicate and collaborate with one another, especially during complex cases such as this GIST surgery. Leaning on each other’s area of expertise, while sharing the same goal of doing what is best for our patient, leads to successful outcomes only achieved by working together.
See Dr. Maithel and Dr. Willingham performing this innovative procedure in the video below!
About Dr. Maithel
Shishir K. Maithel, MD, FACS, Assistant Professor of Surgery, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, is a surgical oncologist at Winship Cancer Institute. Dr. Maithel specializes in treating gastrointestinal cancers, cancer of the liver, bile duct and pancreas, and retroperitoneal sarcoma. Dr. Maithel joined Emory in 2009 from Memorial Sloan-Kettering Cancer Center in New York where he completed his fellowship in both surgical oncology and hepatopancreatobiliary surgery. He completed his residency and internship at Beth Israel Deaconess Medical Center at Harvard Medical School. Dr. Maithel earned his Medical Degree at the University of Chicago, Pritzker School of Medicine, graduating Alpha Omega Alpha.