UF Health’s first robotic Whipple procedure provides hope
Ziad Awad, MD, performs minimally invasive surgery to treat pancreatic and ampullary cancer.
Maureen Stowell and her husband, Richard, reside in the quiet Florida town of Ormond Beach, where she enjoys spending time with her sons and grandchildren. As a retiree, she can often be found in the garden, tending to her fruits and vegetables — that is, if she isn’t busy baking for those grandchildren.
Stowell had been working a part-time job in retail to stay active when she began to experience fatigue. She lost 35 pounds. A side effect of the new job? Maybe.
However, her body began to tell her that something was wrong with her digestion, so she sought an exam from her doctor in Port Orange.
A few tests and an endoscopy confirmed a diagnosis of ampullary cancer, which is found in the ampulla of Vater — a very small section of the bile duct at the head of the pancreas.
Stowell’s doctor was quick to recommend surgery to remove the tumor and treat her cancer.
Her doctor asked: “What kind of surgeon do you want? Good, or the best?”
The answer being obvious, her doctor referred her to Ziad Awad, MD, medical director of minimally invasive surgery at UF Health Jacksonville.
Upon first examination, Awad recommended the robotic Whipple procedure.
For UF Health and Awad, the fully robotic Whipple would be a first. Today, it is one of only a few surgeries of its kind performed in the state.
The robotic Whipple is the most minimally invasive option for the procedure and results in less blood loss, a shorter hospital stay, a shorter recovery time and fewer complications.
“Only around 30 percent of pancreatic cancer patients qualify for the Whipple due to the size and location of the tumors,” Awad said. “Stowell was an ideal candidate; the cancer was caught early, and the anatomy was favorable for this method.”
First introduced in 1935 by Allen Oldfather Whipple, MD, the procedure is considered the most promising surgical option for patients diagnosed with pancreatic cancer and ampullary cancer. It is a surgery in which the head of the pancreas, gallbladder, bile duct and parts of the stomach and small intestine are removed. The organs are then reconnected to allow for normal digestion again.
“Performing the first robotic Whipple at UF Health Jacksonville is a significant accomplishment for Dr. Awad and his team,” said Scott Lind, MD, a surgeon at UF Health Jacksonville. “The Whipple procedure is perhaps the most complex operation performed by oncologic surgeons, and it requires a highly skilled surgeon and operative team.”
Because of the surgical expertise required, the American Cancer Society recommends having the surgery performed by an experienced surgeon in a hospital that accommodates at least 15 to 20 Whipple procedures every year. Awad performs about 40 each year, treating pancreatic cancer, pancreatitis and neuroendocrine tumors.
Awad and his team use the da Vinci Xi, an advanced surgical system that features robotic arms to allow for greater stability. The surgeon is in complete control of the da Vinci and guides the surgical instruments on high-definition monitors.
With instruments that provide better dexterity and greater range of motion than the human hand, Awad maintains more control and precision than one would see in traditional open operations and even some laparoscopic procedures. The true advantage of robotics, according to Awad, is the improved ergonomics that help decrease the impact of fatigue on the surgeon.
“The nimble movements, 3D visualization and ease of suturing with robotics are unmatched,” Awad said. “The medical field is moving toward the use of robotics to improve patient outcomes.”
During the procedure, Awad removed Stowell’s bile duct, duodenum, gall bladder, head of the pancreas and 2 inches of her stomach. The team then completed three reconstructions to reattach remaining organs and allow for normal digestion.
“I credit teamwork for the phenomenal outcome of this surgery,” Awad said.
The six-hour procedure required coordination among two surgeons and two anesthesiologists, along with two anesthesia technicians and other operating room personnel.
“The care I received was excellent. The entire staff was wonderful to me,” Stowell said. “When I left the hospital, I saw a double rainbow and I knew everything would be OK.”
The procedure went extremely well and, as a result of the minimally invasive, robotic approach, Stowell experienced less pain and a shorter hospital stay than a patient would with a standard open procedure.
“Patients who undergo this complex oncologic operation also receive state-of-the-art postoperative care by our surgical critical care team,” Lind said. “The technical expertise of the surgeon and the care delivered in the perioperative period are critical.”
Stowell looks forward to continued healing and good health. Other than a few dietary restrictions, she has returned to her usual schedule. She has completed her first rounds of chemotherapy and will have a few more months of treatment for the remaining cancerous cells.
“Despite chemotherapy, I feel fine most days and look forward to getting back in the garden,” Stowell said. “I am so thankful to have my husband’s support and my sons close by. I am feeling fine after my surgery and look forward to spending more time with my family.”