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Physician Update - Can pancreatic surgery be improved?

Physician Update Fall 2010

Can pancreatic surgery be improved?

By: Ramsey Flynn
Date: September 1, 2010

Laparoscopes in hand, surgeons continue to refine the Whipple

Though Johns Hopkins is widely known for its dominant mastery of the Whipple procedure which stands as the primary surgical therapy for certain pancreatic cancers, the operation remains one of medicine’s most arduous undertakings—for both surgeons and patients.

But a handful of intrepid practitioners have made inroads with minimally invasive laparoscopic techniques in recent years, and a payoff is beginning to emerge. Surgeons Barish Edil and Martin Makary have led the group here in amassing over 60 procedures of the more modest distal surgery, using the laparoscopes to remove both body and tail tumors in troublesome pancreas cases over the past three years.

Encouraged in those cases by better outcomes and faster recovery times—which also accelerate patient access to critical chemotherapy—the pancreas team has lately made the next logical leap. They’re approaching the Whipple operation using laparoscopic techniques in which surgeons use minimally invasive instruments to assist in performing a traditional Whipple.

The early results, says Edil, are raising his team’s confidence. Soon, he predicts, his group will be able to “do this procedure more routinely in a selected group of patients through four or five 1-centimeter incisions,” with results that are comparable to those in the open procedure. (The open Whipple remains the field’s gold standard, in which Hopkins surgeons have reduced the procedure’s mortality rate to less than 2 percent.)

Edil says this new approach relies on a rare combination of skills, enhanced by Hopkins’ established experience with the pancreas. “First and foremost you have to be a pancreatic surgeon,” says Edil. “You also must have laparoscopic capabilities, which is really a different skill set.”

Although incisions are obviously smaller in the minimally invasive approaches, Edil predicts there will be no compromise to the traditional Whipple.

“Our philosophy,” he says, “is to do the exact same operation laparoscopically as we would do open.”

Please call 410-933-PANC to refer a patient.

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