The Whipple procedure is one of the most technically challenging abdominal surgeries – and it is also a UT Southwestern specialty. In this video, Dr. Herbert Zeh, Chair of our Department of Surgery, and Dr. Patricio Polanco, a GI and robotic surgery expert, take you inside the operating room for a firsthand look at this complex surgery.
Welcome to Ut Southwester Medical Center, pancreatic surgery including the pancreaticoduodenectomy and the distal pancreatectomy are among the most technically challenging complex abdominal operations performed by surgical oncologists. Our surgeons at UT Southwester are some of the busiest and most experienced surgeons in this procedure. And we're very pleased to be able to share with you this experience today. My name is Patricio Polanco. I'm a surgical oncologist. I'm also the director of robotic surgery from a Ut Southwester. Today, I will serve as the surgeon and at the beds, I will have Doctor Herbert, say chairman of the Department of Surgery and pioneer in robotic pancreas operations. We started mobilizing the large intestine or colon and proceed to mobilize. Also the first part of the small intestine called duodenum. This allows for vast exposure of the pancreas and the retroperitoneal structures. We use these robotic instruments to cauterize and divide different vascular structures. Once the first part of the small intestine is completely mobilized, we divide it with stapler device. This stapling device allows you to staple on each side and cut in between with a sharp blade. We then turn our attention to the stomach and the first part of the duodenum. And once we circumferentially dissected, it, we divided again with a sting device. After the proximal duodenum or small bowel is divided, we turn our attention towards the major blood vessels that feed the liver, that is the hepatic artery, the gastroduodenal artery, as well as the common bowel duct removing the gallbladder is a standard part of the robotic. We will procedure at UT Southwester. We have performed hundreds of robotic Andres resections with our expertise, we have proven that we can perform the same high quality operation that we will perform open with a minimal invasive approach. The main common bile duct is circumferentially dissected and divided with a new stapling device to prevent bio spillage. We then create a tunnel behind the pancreas neck. And once we identify the site of transection of the pancreas, we use robotic scissors with energy to divide the pancreas at Ut Southwester. The robotic weel procedure is performed by two surgeons, one of them at the bedside, assisting the consul surgeon who's manipulating and operating the robot arms. We believe that having two expert surgeons in the room performing these procedures makes a difference for the outcomes of the operation. We then very carefully mobilize the posterior aspect of the pancreas of the main vessels that include the superior synthetic artery and vein. This is considered one of the most delicate part of the operation. For this. Once again, we use energy devices, vessel sealer, bipolar energy and monopolar energy. What we've done is take the branches that were draining the sate and the duodenum off and then that exposed that. So you can see multiple colonic branches and then our S ma right there, hepatic artery, splenic artery, neck of the pancreas. So this is what it should look like when you're all done. We introduce a Endocatch bag and we use this bag to remove the specimen, which includes the duo, the pancreas head, the gallbladder and the common bile duct. Once a specimen has been removed, we examine it to confirm a complete removal of the tumor with clean edges with cancer free margins. Occasionally we send a specimen to pathology for the extra pathologist to confirm that the margins are free of tumor. Yeah. After the tumor has been completely removed, we proceed with the reconstruction phase of the surgery. First, we reconnect the pancreas to the small intestine using robotic suture instruments. For this. We use different suture material and small needles. Some of these structures that we're reconnecting are anywhere between 3 to 5 millimeters wide. The robot allow us for amplification of the field with great visualization of the structures that we are suturing. It also allow us to suture with both arms right or left, regardless of the dexterity of the surgeon. Here, you can see the pancreat Oros toomy or the pancreas to this mobile connection completed. We then proceed to reconnect the bile duct to a different segment of the small intestine. This is also known as Hepaticostomy anastomosis. For these, we create an opening in the small bowel. We use again, very small suture material and needles to reconnect the bile duct to a small intestine. These new connections or anastomosis are performed in a very precise fashion. The approach is similar to the open technique. However, the robot allow us to do more precise suturing given the 3d magnification of the surgical field. In this case, we're seeing two fine robotic needle drivers. This instrument allows us to perform complex reconstructions with high level of precision at Ut Southwester. Most of our patients get a robotic wile procedure. As we have a vast expertise in this approach, we have shown that the patients have less pain, patients recover faster and they can move to the next phase of treatment sooner, whether that is received chemotherapy radiation therapy or any subsequent treatment. After the common balduc anastomosis or new connection is completed. We proceed with the last anastomosis, which in this case corresponds to the duodenotomy. In this particular patient, we preserve the entire stomach and divided the the or and preserving the pyro which is a muscle that functions like a valve connecting the stomach to the small intestine. We perform this suture in a running fashion with a barbed suture. We confirm adequate completion of all our three connections or anastomosis and we confirm adequate hemostasis or lack of bleeding throughout the entire abdomen at this time, a majority of the robotic pancreas operations are performed at select high volume centers where institutions have experts in hepatobiliary surgery and minimally invasive surgery. We're fortunate here at UT Southwester to have one of the busiest, minimally invasive robotic pancreatic programs in the world.
