Minimally invasive Whipple procedure possible with robotic surgical systems

The Whipple procedure, a complex surgery also known as pancreaticoduodenectomy, is the treatment of choice for patients with pancreatic cancer located at the head of the pancreas. During the complex Whipple procedure, the pancreatic head, duodenum, bile duct, and gallbladder are removed.

Surgery is the only chance of curing pancreatic cancer, said Dr Yoong Boon Koon, a consultant hepatopancreatobiliary (HPB) surgeon. The complex Whipple procedure is commonly done as an open surgery, takes up to 6 hours and requires highly skilled hands. However, robotic surgical systems such as the da Vinci Xi, allow for this challenging surgery to be performed with a minimally invasive approach through a few keyhole incisions, said Yoong. He successfully conducted the Whipple procedure using the da Vinci Xi in June 2023.

The minimally invasive robotic surgical option is only suitable for patients in the early stage of cancer or precancerous conditions. “Most patients, except those with poor lung or heart functions and poor general health, are suitable for robotic Whipple procedure. Patients with multiple previous abdominal surgery can make this surgery more challenging,” said Yoong.

Nevertheless, robotic-assisted surgery has many benefits such as smaller incisions required compared to traditional surgery, the dextrality of the robotic arms allows it to perform better in deep and narrow spaces that is difficult to access with hands; and with the magnifying view of the robotic controlled camera, anatomy is better visualized making injuries less likely. With that, patient recovery is much faster, and patients may be discharged earlier due to the smaller wounds and less physiology disturbance. They experience less pain and are at a lower risk for infection and complications which also allows for earlier discharge.

Robotic-assisted surgery is more likely to lead to a higher success rate when case selection is done correctly. If there are challenges to proceeding with robotic-assisted surgery, the surgeon has the option of converting it into an open surgery.

One of the deadliest cancers

Pancreatic cancer is known to be one of the deadliest cancers in Malaysia. Although it may not be as common as colon, breast or lung cancer, pancreatic cancer has an unfavourable prognosis as it is usually diagnosed late.

The most common signs of pancreatic cancer are:

●        Jaundice

●        Intestinal obstruction

●        Loss of appetite and weight

●        Abdominal pain or mass

“Unfortunately, these symptoms often present late and curative treatments are not feasible on diagnosis,” said Yoong. However, for those detected during screening as indicated by raised CA19-9 in the blood test or pancreatic mass on ultrasound, surgical removal of the tumour is the only chance of cure. Those detected with precancerous tumours have the best prognosis and surgical resection would usually cure them. Hence, those who experience the signs of pancreatic cancer should be advised to go for screening as soon as possible, he added.

Further, for pancreatic cancer that is still localized to the pancreas (stages 1-3), surgical resection is followed by chemotherapy, while for cancer that has spread to other organs (stage 4), palliative chemotherapy is the treatment of choice.