Inside Northwell’s push for robotic Whipple surgery in pancreatic cancer care

For a small fraction of the American population, a diagnosis of pancreatic cancer can feel like a death sentence. It is notoriously as difficult to detect as it is to treat, and of the roughly 66,000 Americans who develop pancreatic cancer this year, more than three-fourths will die of the disease. Only about one in 10 will live five years or longer.

When cancerous tumors develop in the pancreas, for the few eligible for surgery, the Whipple procedure offers the best chance of survival. During the operation, the head of the pancreas and other vital surrounding organs are removed and then painstakingly reconnected. Those who undergo a successful Whipple procedure can see their odds of living five years or longer jump to 25 percent.

But here is the catch: the operation not only carries the risk of complications, but also demands a high level of skill from the surgeon.

Dr. Matthew Weiss, director of the surgical oncology program at Northwell Cancer Institute, met with Dr. Steven Mitchell Cohen, a leading expert in robotic pancreatic surgery, to discuss the limited but noticeable advancements being made in the procedure.

“It used to be that half the people died from the operation,” Weiss said. “During the ’80s and ’90s, the mortality rate for the operation went down dramatically. Patients are not dying from the operation itself, but the complication rate has remained high.”

To access the pancreas, the standard Whipple procedure calls for an open surgery where a large incision is made through the belly. But Weiss and Cohen say that a rising number of operating rooms are starting to embrace a less invasive, more precise alternative to the standard surgical technique using a new tool: robots.

Cohen, who has been tapped as the institute’s director of robotic pancreatic surgery, aims to expand the use of the robot-aided procedure in the Northwell health system, including at  Long Island Jewish Valley Stream.

How does it work?

A physician seated at a computer console can remotely control a robotic arm equipped with a camera that offers and records a high-definition 3D view of the surgery. Surgeons controlling robots holding surgical instruments can make smaller incisions and more precise maneuvers.

“The robot allows for a great deal of suturing and stitching, similar to what I can do during an open surgery,” Cohen said. “And the visual is very impressive since you can see it in 3D. Robotics is essentially like we are standing inside the patient and using all our joints, fingers, and wrist to be able to suture and stitch.”

The promises and pitfalls of robotic Whipple surgery

Hospitals say the dazzling new tool has been shown to benefit patients by offering comparably quicker recovery times, less pain, and shortened hospital stays. Many healthcare officials like Dr. Cohen are holding up the robotic Whipple procedure as a possible technological answer to the existing challenges of traditional laparoscopic surgery.

Not all in the healthcare community, however, are fully sold on the idea.

Given limited research and the technology not widely adopted, it is too early to definitively say whether robotic pancreatic surgery has a higher success rate, or delivers better health outcomes, than traditional open surgery.

While limited studies show promise, researchers argue that a patient’s overall survival is still determined by the type and stage of the cancer rather than the type of surgical approach. In this sense, enhancing a surgeon’s touch in the operating room via robotics may not be the game-changing innovation some hospitals tout it is.

Skeptics also point to a growing body of studies that suggest robotic-assisted surgeries tend to be, overall, longer to perform and more expensive than their traditional counterparts.

Rather than shift toward more robo-enhanced surgery methods, they argue, higher importance should be placed on a combination of health strategies — from enhancing early detection to advancing new immunotherapy treatments — that can better dampen the disease’s daunting mortality rate.

While the question of whether robotic pancreatic surgery holds a meaningful edge over the standard technique is far from settled, Cohen argues its practical benefits on the operating table are hard to deny.

“From a cancer standpoint, I think it is reasonable to say that robotic pancreatic surgery is equal in removing tumors and reconstructing and reconnecting organs than the standard procedure,” Cohen said.

“But to be equal in that sense, and to be able to do some of these highly technical tasks with robots that otherwise could not be done through the normal procedure is very helpful.”

Weiss acknowledges that more research is needed to determine if shorter recovery times and reduced pain from robotic-assisted surgery will translate to better survival outcomes against the disease but emphasizes that Northwell is fully committed to ramping up the use of the technology.

“Our ultimate goal is to make this the pancreas center for complex robotic pancreas surgery, certainly in the Northeast,” Weiss said. “I believe the robotic Whipple surgery is not the future. It is the present. It is the way pancreatic surgeries are going to be done.”

Have an opinion on this article? Send an email to jlasso@liherald.com.