When cancerous tumors are detected within the head of the pancreas, there is one potentially lifesaving surgery that can remove them before they spread.
It also happens to be one of the most complex abdominal surgeries.
The Whipple procedure, or pancreaticoduodenectomy, involves removing the head of the pancreas and part of the small intestine, gallbladder, nearby lymph nodes, and part of the stomach, if necessary, and reattaching the remainder of the pancreas, bile duct, and stomach to the small intestine to allow transit of food and digestion. The Whipple procedure has traditionally been performed through a large incision to access the pancreas, requiring an extended hospital stay and long recovery.
At UT Southwestern, our pancreatic cancer surgeons have specialized training in robotic-assisted pancreas surgery, a more precise approach through smaller incisions that has been proven to benefit patients with faster recovery times, less pain, less use of pain medication, and prompter return to work. It has also been shown to have comparable cancer treatment results with fewer complications than the open surgery approach.
Besides the Whipple procedure, several other robotic pancreatic surgeries are routinely performed at UT Southwestern, including distal pancreatectomies, tumor enucleations, and bypass procedures for chronic pancreatitis, among others.
Initially led by robotic pancreas surgery pioneer Herbert Zeh III, M.D., Chair of the Department of Surgery at UT Southwestern, our gastrointestinal surgery program has become one of the few international centers of excellence for this approach. Patients travel from throughout the U.S. to receive robotic Whipple surgeries at UTSW.
Using the da Vinci robot system, our surgeons employ:
- Computer-guided surgical tools that are steadier and smaller than a human hand
- 3D real-time visualization inside the abdomen
- Integrated near-infrared imaging technology
- Small incisions that are less than half an inch each, rather than one large incision ranging from 6 to 12 inches
- Remote and bedside surgical expertise for optimal outcomes
The Whipple procedure is the only treatment with curative potential for patients with early-stage pancreatic head cancer. As early adopters and developers of the robotic-assisted pancreatic surgery, at UT Southwestern we consider it part of our mission to share our knowledge and increase access to this cutting-edge technique for surgeons across the U.S. and around the world.
How does the robotic-assisted Whipple procedure work?
Both traditional and robotic-assisted Whipple surgery require a tight-knit team of surgeons, physician assistants, and OR nurses.
The da Vinci robot systems in our operating room and Simulation Center are equipped with state-of-the-art, miniaturized surgical tools and a lighted camera, which are attached to a series of robotic arms.
Real-time, 3D-HD images from the camera are displayed on large monitors throughout the operating room, as well as within the computer console pod in the OR. The robotic arms provide a wider range of motion and more steadiness than human hands alone; paired with the surgeon’s expertise and training on the machine, the result is a more precise and less-invasive procedure.
One surgeon is seated at the robot console to control the robotic arms, and an assistant surgeon is positioned at the bedside with the surgical team; we stay in constant communication throughout the procedure.
- After the patient is put under general anesthesia and the sterile field is set up, we insufflate the patient’s abdomen with carbon dioxide gas to create more room to operate.
- We make a series of small incisions in the abdomen, most of which are less than half an inch long.
- Surgical instruments and a camera are inserted into the small incisions, allowing for better visualization.
- The robotic surgical instruments are controlled by the console surgeon to remove the head of the pancreas and parts of the small intestine, gallbladder, nearby lymph nodes, and stomach, if necessary.
- The remainder of the pancreas, bile duct, and stomach are reattached to the small intestine using delicate and precise suturing techniques. Some of these structures, such as the pancreatic duct, can be one-tenth of an inch.
Depending on the type of tumor, some patients may need chemotherapy or radiotherapy after surgery to decrease the chances of tumor recurrence.
Robotic-assisted Whipple surgery is complex and can take four hours or longer to perform. Despite the duration, the smaller incisions and better visibility offer patients substantial benefits, including:
- Faster recovery times
- Less blood loss
- Less scarring
- Lower risk of wound infection
- Reduced pain (and therefore less pain medication)
And, in the hands of an expert surgical team, robotic-assisted Whipple procedures are effective. In recent years, my research team has shown that minimally invasive, robotic-assisted Whipple surgery is not only safe and feasible but reduces wound infections, transfusions, and length of hospital stay. Additionally, we have shown that in high-volume centers, robotic-assisted pancreatoduodenectomy outcomes are equivalent to those of patients who had laparoscopic surgery but with a lower rate of conversions to open surgery.
UT Southwestern is one of the world’s highest-volume centers for robotic-assisted Whipple procedures. We care for patients with complex pancreatic tumors that other centers are not equipped to treat surgically.
Academic excellence in robotic-assisted surgery
Because of the expertise required to provide robotic-assisted Whipple, we have invested in a dedicated training robot system in our Simulation Center – one of the largest facilities in the nation at 49,000 square feet and a training destination for residents, fellows, and practicing GI surgeons worldwide.
Our trainees and visitors can hone their skills on virtual reality training platforms, sharpen procedural maneuvers using biosynthetic material that simulates human tissue, and use the Sim Center robot system on demand, 24/7. As the Director of Robotic Surgical Training for the Department of Surgery, I led a team of surgical educators and researchers that has developed a comprehensive robotic training curricula for residents and surgeons. Our work validating this training model has also been published in recognized surgical journals.
Visiting international surgeons are not licensed to operate on patients in the U.S., but in our Simulation Center they can immerse themselves in hands-on training rather than just observing procedures and techniques. UT Southwestern surgeons have also visited those surgeons’ hospitals to provide additional guidance and skill refinement in robotic-assisted techniques.
An example of this international collaboration was the visit of Miha Petric, M.D., a pancreas surgeon from the University of Ljubljana, Slovenia, in fall 2022. Dr. Petric was at UT Southwestern for five weeks, observing robotic pancreas and liver surgeries in real time and practicing techniques with our Simulation Center robot. After training with our team, he took the techniques home and began offering lower-complexity robotic-assisted pancreas surgeries. A few months later, I traveled to Slovenia to proctor Dr. Petric and his team in robotic-assisted Whipple procedures, the first ones in the Balkans region of eastern Europe. To date, the Slovenian surgeons we trained have performed several robotic-assisted Whipple procedures at their hospital with excellent results. We keep in touch, consulting on cases and discussing options together.
In addition to the surgeons from Slovenia, we have hosted and trained surgeons from Mexico, Peru, Japan, Costa Rica, Egypt, and Israel. With the support of the Department of Surgery and the Simulation Center, we constantly organize robotic training courses for different surgical specialties such as hernia surgery, colorectal surgery, and bariatric surgery, among others.
As a leader in the field of robotic surgery, UT Southwestern embraces the opportunity to share knowledge, surgical techniques, and research surrounding pancreas surgery, and we are dedicated to pursuing advanced treatments in the fight against pancreatic cancer.
All Access: Inside the UTSW Simulation Center
As one of the largest medical training facilities in the nation, our Sim Center offers health care learners the opportunity to get practical experience on cutting-edge technologies, such as robotic surgery.