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First Robotic Pancreatectomy in Boston

Using BIDMC’s state-of-the-art surgical robot, surgeons Mark Callery, MD, and Jim Moser, MD, performed Boston's first robotic pancreatectomy on June 14

  • Date: 8/14/2012

Surgeons Mark Callery, MD, and Jim Moser, MD, with Elena Canacari, RN, CNOR

For many months, Jonathan Archer, a 45-year old husband, father, and mechanical engineer from Mansfield, Mass., had been suffering an array of gastrointestinal symptoms. Last April, he underwent several screening exams that revealed a mass on his pancreas. After doing extensive research and learning about the Department of Surgery's expertise and outcomes in pancreatic surgery, Archer insisted on coming to Beth Israel Deaconess Medical Center (BIDMC) for his treatment.

On June 14, Archer underwent a distal pancreatectomy with splenectomy at BIDMC - the surgical removal of the tail of his pancreas and his spleen. That was not unusual, as this is the definitive treatment for his type of cancer, a neuroendocrine tumor of the pancreas. What made Archer's operation truly remarkable was that it was the first robot-assisted pancreatectomy performed in Boston. Using BIDMC's state-of-the-art surgical robot, pancreatic surgeons Mark Callery, MD, and Jim Moser, MD, needed just six half-inch incisions to perform the operation and achieve this surgical milestone.

Surgeons are international leaders

Callery, Chief of General Surgery, and Moser, Executive Director of the BIDMC Institute for Hepatobiliary and Pancreatic Surgery, are international leaders in pancreatic surgery and have collectively performed hundreds of open and minimally invasive pancreatectomies. They worked together to perform Archer's operation, using the most sophisticated of BIDMC's two robots, with assistance from an entire surgical team.

Moser, who came to BIDMC from the University of Pittsburgh Medical Center (UPMC) in the spring, is among a handful of world leaders advancing robot-assisted pancreatic surgery. In fact, Moser has performed 200 robot-assisted pancreatic operations thus far, including the very complex Whipple procedure, which is used to treat patients with certain benign and malignant pancreatic diseases.

A top center

"As a top center for pancreatic surgery, we're thrilled to have the surgical talent, experience, technology, and expertise to be able to offer patients throughout New England and beyond the best possible treatment options, including robot-assisted procedures," says Jennifer Tseng, MD, MPH, Chief of Surgical Oncology. Both she and Tara Kent, MD, also perform robotic pancreatectomies.

The use of laparoscopic approaches in pancreatic surgery has been slower to catch on than in many other surgical specialties for several reasons: the difficult-to-access location of the pancreas, the organ's close proximity to major blood vessels, and surgeons' concern about being able to remove all of the patient's cancer.

Yet recent studies indicate that laparoscopic distal pancreatectomy (similar to the procedure Archer underwent) is safe and feasible when performed by experienced surgeons. This is good news for patients, because compared to the open procedure, the minimally invasive approach results in a shorter hospital stay, less pain, less blood loss, and a faster recovery.

Still, the purely laparoscopic approach has a potential drawback that has prevented it from being widely accepted. In a significant percentage of cases, surgeons have to convert mid-operation to an open procedure to ensure a safe and successful operation.

But the robot-assisted approach appears to overcome this limitation: first, by giving the surgeon a magnified 3D view of the surgical site, and second, by improving his or her dexterity and ability to manipulate instruments safely within the body.

Until recently, however, little data existed to indicate whether the robot-assisted approach is, indeed, better than laparoscopic approach. A paper now in press in the Annals of Surgery, authored by Moser and his colleagues at UPMC, which compared the outcomes of 124 patients who had undergone either minimally invasive laparoscopic distal pancreatectomy or the robotic approach, provides some answers.

Study demonstrates advantages

The study demonstrated that the robotic approach offers three significant advantages: a reduced risk of conversion to an open procedure and its attendant risks, a decreased risk of significant blood loss, and improved cancer outcomes in patients with pancreatic ductal carcinoma. Surprisingly, the authors found that the robotic approach was also faster, which reduces the time patients must spend under anesthesia.

While acknowledging that these findings must be confirmed in larger, multi-institutional studies, Moser comments that "the improved visualization and dexterity of the robotic approach may offer more patients the option of minimally invasive surgery. Consequently, we'll advance this approach here at BIDMC."

For patients like Archer, who was out of the hospital in just five days, back at work in under five weeks, and according to Callery has an "excellent prognosis," having that option made a big difference. "I even went boating the weekend after surgery," says Archer, joking that this probably would not have been approved by his surgeons. "Dr. Callery and Dr. Moser get an A-plus, plus, plus from me," he says. "The most important thing, of course, is that they completely removed the tumor, but they did so with very little disruption to my life."

The Department of Surgery at BIDMC is a leader in robotic approaches to surgery across many specialties, including urology, colon and rectal surgery, and, more recently, thoracic surgery, as well as training surgeons from around the country in robotic techniques. "This latest option for patients, made possible by a world-class team, is building on an already strong foundation of surgical leadership and innovation," says Department of Surgery Chairman Elliot Chaikof, MD, PhD.