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SISD Surgeons Now Offering Robotic Whipple Procedure

Feb 23, 2020 03:21PM ● By MED Magazine

In the treatment of advanced cancers of the foregut, chemotherapy and surgery are typically used in tandem for optimal outcomes. 

Unfortunately, complex open surgery with a lengthy recovery period can delay a patient’s ability to either initiate or resume chemotherapy. That, says surgeon Mike Person, MD, FACS of Surgical Institute of South Dakota, is a critical factor in cancer treatment. 

“Our goal is always to remove as much of the cancer as possible and then get them well enough for chemotherapy as quickly as possible,” says Dr. Person. 

The Whipple procedure for advanced pancreatic cancer is a prime example. Whipple (pancreaticoduodenectomy) is a large and complex 4 to 5-hour operation involving the removal of the proximal portion of the pancreas along with some of the surrounding intestine and a portion of the bile duct. Person is one of only a few surgeons to perform the Whipple procedure in the Sioux Falls area. He is the only physician in the area, now offering the procedure robotically. 

“To progress the care of pancreas cancer patient’s survivability, it’s about chemotherapy,” says Dr. Person. “So we want to see how we can improve this surgery to get them into or resume chemotherapy as quickly as possible. The robotic surgery gives us a tool to try to do that. We are trying to optimize patient recovery by moving to a minimally invasive approach when possible.”

As a high-volume pancreatic cancer center, SISD, on the Avera McKennan University and Health Center, performs 20 and 40 Whipple procedures a year. Person says the robotic Whipple procedure was the logical next step in an evolution that has been underway at SISD for a decade. 

“We had been doing distal [back half] pancreatectomies laparoscopically for several years,” says Person. “Then, we started doing the procedure robotically, which greatly improves our ability to save the spleen, if indicated, and increase the overall oncologic resection.  Most distal pancreatic surgery patients are now going home in a day or two.”

Minimally invasive stomach surgery patients often recover faster, possibly even returning home the next day, even those who have had partial, subtotal or complete gastrectomy.  This compared to a full week in the hospital after the traditional open operation. 

“What holds people in the hospital is the incision and the pain,” says Dr. Person. Minimally invasive techniques make both issues much less relevant, along with reducing both the risk of infection and the need for narcotics.

Surgery on the esophagus has undergone a similar progression at SISD. Dr. Person and his colleagues now perform the transhiatal esophagectomy robotically, which requires only small incisions in the abdominal wall and neck. 

“We have been treating these diseases for decades without significant surgical changes, but in the last several years, we have been able to significantly reduce recovery times, minimize pain, and decrease hospital length of stay, even with large and complex operations,” says Dr. Person. “These are still very complex operations, with many of the same risks and complications, but we have been able to improve the patient’s overall experience, without compromising, and in some instances, enhancing oncologic outcomes.”

Dr. Person is an Associate Professor in the Department of Surgery, Sanford School of Medicine and performs robotic foregut surgery on the Avera McKennan Hospital and University Health campus.