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Mass General Brigham Urology Leading the Way in Minimally Invasive and Noninvasive Cancer Care

5 minute read
Two doctors looking at medical scans on computer monitors

Last year, the urology departments at Brigham and Women's Hospital and Massachusetts General Hospital came together to form the Mass General Brigham Department of Urology. Each of these esteemed programs brings impressive strengths to the table.

For example, the Brigham's Department of Urology is a pioneer in adopting high-tech tools for minimally invasive and noninvasive cancer care. According to Intuitive, the manufacturer of da Vinci robotic surgical systems, Brigham Urology ranked first in New England in 2024 for:

  • Volume of urological robotic surgeries
  • Volume of procedures using the da Vinci SP (for single-port surgery)

Brigham Urology was also No. 1 in the region for focal treatment of prostate cancer using robotic high-intensity focused ultrasound (HIFU) in fiscal year 2024, reported EDAP TMS, the manufacturer of the Focal One HIFU Robotic System.

Statistics cited in this story reflect procedures conducted at the Brigham and at Brigham and Women's Faulkner Hospital.

Advancing the use of new robotic platforms to improve outcomes

Brigham urologists performed more than 800 robotic surgeries in 2024, nearly 50% more than the next-highest-volume center in New England. In addition to surgery for localized prostate cancer, the Brigham is using robotic technology in growing numbers of surgeries for kidney, bladder, testicular, and penile cancers.

"Robotic technology is pervasive throughout the treatment of all our disease states," says Steven L. Chang, MD, MS, chief of Urologic Oncology at the Brigham. "That includes all urologic cancers as well as noncancerous cases. Utilizing robotics allows us to achieve our surgical goals effectively while reducing undue harm to patients."

A key recent development was Brigham Urology's adoption of the da Vinci SP in 2024. Dr. Chang notes that urologists traditionally were experts in operating on the deep pelvis using extraperitoneal techniques. The advent of robotics and laparoscopy, however, shifted the focus to intraperitoneal approaches. This change improved outcomes in many ways but also increased the risk of injury to other organs in the intestinal cavity and created excessive scar tissue if multiple surgeries were required.

The single-port system, Dr. Chang observes, enables urologists to return to their roots as extraperitoneal specialists. "And all of the attributes associated with minimally invasive surgery are heightened, accentuated by the fact that we're going in through a single port," he adds.

In 2024, the Brigham conducted more than 160 urology procedures with the da Vinci SP — over 50% more than the second-ranked center in New England. Thanks to its burgeoning high-volume expertise, Brigham Urology is steadily shortening recovery times for prostate surgeries.

"The majority of our patients who undergo radical prostatectomy with this technology are going home the same day," Dr. Chang says. "It's not just about our surgeons getting better. It's also our anesthesiology colleagues and our nursing staff knowing exactly how to care for these patients and the development of protocols to minimize or completely avoid the use of narcotics following surgery. All of that comes with volume."

Treating prostate cancer without scalpels

Several medical staff gathered in a room with equipment and monitors

Brigham urologist Alexander P. Cole, MD, was the first in New England to adopt a robotic surgical platform that can treat certain localized cancers with no incisions. In 2024, Brigham Urology led the region in the number of robotic HIFU procedures performed.

"For years, we had treatments for localized prostate cancer ranging from active surveillance for low-risk disease to more aggressive treatments like surgery and prostate radiation, which were highly effective but could lead to incontinence, erectile dysfunction, and other long-term urinary and rectal symptoms," he says. "For me, it logically made sense that something in the middle of these two extremes would be more ideal for small, intermediate-grade prostate cancer. That was focal therapy."

The first company to experiment with HIFU ablation of prostate tissue was EDAP, whose first-generation systems were built in France in the early 1990s. These early systems were cumbersome and generally focused on ablation of the entire prostate. With the establishment of multiparametric prostate MRI and targeted biopsy as the standard of care for diagnosing prostate cancer in the late 2010s, urologists were able to define the anatomy of small prostate cancers more precisely.

Combining focused ultrasound with the highly accurate information obtained from prostate MRI and targeted biopsy enabled doctors to treat small cancers while leaving the remaining prostate unharmed. Researchers at University College London helped to usher in the modern era of using MRI and other advanced imaging modalities to identify small but potentially lethal cancers and then applying focused energy such as HIFU to kill these tumors.

Upon joining Brigham Urology in 2021 following a fellowship in London, Dr. Cole became the first faculty member to offer HIFU, a specific modality for performing focal therapy. During the procedure, an ultrasound transducer (inserted via the rectum) projects high-intensity ultrasound waves to heat and destroy cancer cells in a precise area of the prostate.

The Brigham was the first center in New England to have a robotically controlled, MRI-guided HIFU machine. The institution has also invested in technology to identify which patients are ideally suited for HIFU treatment. In fiscal year 2024, Dr. Cole completed the most robotic HIFU procedures in New England.

According to Dr. Cole, a successful HIFU program starts with having interdisciplinary expertise.

"You need to work closely with the radiologists and have good imaging to determine exactly where a tumor is located and how best to go after it," he says. "And then afterwards, you need ongoing monitoring of the prostate, which means looking at the imaging and the blood tests to make sure the cancer is well-controlled. It also requires commitment from the patient, who needs to be okay with ongoing monitoring once the cancer is treated."

"Increasingly, cancer care is focused on not only curing the patient but also maintaining quality of life," adds Adam S. Kibel, MD, chair of Mass General Brigham Urology. "For the right patient, single-port surgery or HIFU accomplishes both goals."