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Upstate now offers robotic option for Whipple procedure

Upstate Medical University now offers the robotic Whipple procedure, a complex surgery used to treat certain types of pancreatic cancer as well as some other conditions.

The robotic Whipple procedure is a minimally invasive version of the Whipple procedure or pancreaticoduodenectomy, performed to treat pancreatic cancer.

Either operation involves removing the head of the pancreas, duodenum (first part of small intestine), bile duct, lymph nodes, gallbladder (if present), and sometimes part of the stomach, and then reconnecting the organs so that food can be properly digested.

It can also be used to treat benign or precancerous conditions of the head of the pancreas, neuroendocrine tumors at the head of the pancreas, ampullary cancers, and duodenal cancers.

Upstate joins a small but growing group of hospitals to offer the robotic Whipple. In Upstate New York, only the University of Rochester and Roswell Park in Buffalo offer the robotic procedure.

There were less than 18,000 Whipple procedures completed from 2004-2017 in the United States, according to the National Cancer Database. Of those, only 12 percent were minimally invasive (done laparoscopically or with robotic technology), with less than 400 robot-assisted procedures in total. A high-volume surgical center might see 10 to 20 Whipple-appropriate cases in a year.

Upstate surgeon Mashaal Dhir, MD, FACS, performs both the traditional and robotic Whipple procedures here. He said the hospital started doing the robotic procedure about four months ago and he has performed it on four patients. One had a pre-cancerous condition at the head of the pancreas, one had a neuroendocrine tumor and two had ampullary cancers, located where the bile duct and pancreatic duct join and empty into the small intestine.

The patients tend to feel less pain and it appears their body goes through less stress, so they get back to their baseline faster," Dhir said, not that some patients left three to six days after surgery,

Dhir said only 10 to 20 percent of patients with pancreas cancers qualify for the traditional Whipple procedure and even fewer qualify for the robotic version. Dhir said candidates must have early-stage disease in the region where the bile duct and pancreas ducts meet and be in good enough health to withstand a long surgery, among other considerations.

In the traditional Whipple, the surgeon makes a large abdominal incision to remove and reconstruct affected organs and tissues. For the robotic Whipple, the surgeon operates through several small incisions, using robotic arms equipped with special instruments and a tiny camera. The robotic arms can move more precisely and with a better range of motion than a surgeon's hands, while the camera provides a more complete view of the abdominal interior. Because the procedure is less invasive, patients experience fewer complications and recover more quickly.

The robotic procedure, however, is very complex, and Dhir said it takes longer than the traditional version, anywhere from 8 to 12 hours. Dhir said the team has to be ready for many outcomes, including any problems that would cause them to have to revert to the traditional method.

“We have to be very careful and use meticulous dissection,” he said. “We have to plan out every move and we always have to stay one step ahead.”

Dhir said offering this procedure puts Upstate on the map with centers like Sloan Kettering or Roswell. Previously, he said some of his patients traveled to a big center to have the robotic surgery done.

“Having this state-of-the-art procedure uplifts our program and allows us to serve our patients better because we have the expertise at home,” he said.

To learn more about the robot-assisted Whipple procedure, check out the Informed Patient Podcast.

Caption: Mashaal Dhir, MD, FACS, now offers a robotic-assisted  Whipple procedure.