Page 28 - World Association of Laparoscopic Surgeons - Journal
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WJOLS
Role of Robotics in Whipple’s Surgery
Upper abdominal pain with radiation to back, weight IMAGING
loss and thrombophlebitis are usually late mani-
CT scan: A multiphase helical CT scan is the initial
festations.
diagnostic tool and detects a mass in more than 80% of
Risk factors for pancreatic cancer: cases.
Age Endoscopic ultrasound
Obesity PET scan
Tobacco use MRI
Family history ERCP
Heavy alcohol use MRCP.
Chronic pancreatitis
Prior abdominal radiation WHIPPLE’S SURGERY
Previous H/O partial gastrectomy. Whipple’s surgery is done for:
Cancer of the head of the pancreas
GENERAL CONSIDERATIONS
Cancer of the duodenum
Ductal adenocarcinoma is the most common neoplasm of Cholangiocarcinoma (cancer of the pancreatic end of
the pancreas. Other neoplasms of pancreas include: the bile)
Mucinous cyst adenocarcinoma Cancer of the ampulla
Serous cyst adenoma Whipple operation may also sometimes be performed
Mucinous cyst adenoma for patients with benign (noncancerous) disorders such
Malignant exocrine tumors as chronic pancreatitis and benign tumors of the head
Benign exocrine tumors of the pancreas.
Endocrine
Advantages of Robotic Whipple
– Gastrinoma
– Insulinoma. The robotic Whipple offers patients a minimally invasive
Carcinomas involving the head of the pancreas, the option to the traditional surgeries for pancreatic cancer and
ampulla of Vater, the distal common bile duct and the benign tumors of the pancreas and colon, resulting in the
duodenum are considered together, because they are usually potential for:
indistinguishable clinically; of these, carcinomas of the Less pain
pancreas constitute over 90%. About 75% are in the head Shorter hospital stays
and 25% in the body and tail of the organ. They comprise Faster recovery times
2% of all cancers and 5% of cancer deaths. Risk factors Minimized scarring
include new-onset diabetes mellitus after the age of 45 years, Blood loss
occasionally heralds the onset of early pancreatic cancer. Less complications.
A B
Figs 2A and B: (A) New generation robotic instruments have seven degrees of freedom as the human hand, (B) EndoWrist’ ®
instrument from intuitive surgical (Courtesy: Intuitive Surgical Inc, Sunnyvale, CA)
World Journal of Laparoscopic Surgery, January-April 2012;5(1):39-45 41
