Laparoscopic Whipple Operation

What is new with Laparoscopic Whipple Operation

Whipple operation is perhaps one of the most technically challenging operation in the abdomen. Now, we can do a total laparoscopic Whipple operation ! Amazing !!!

What is removed during Laparoscopic Whipple operation ?

It is amazing that a surgeon can now do whipple operation laparoscopically. This is the operation to remove tumor an the head of the pancreas most of the duodenum, distal common bile duct and some time part of the stomach.

This can be pancreatic adenocarcinoma, pancreatic neuroendocrine tumor and some symptomatic benign pancreatic tumor



Who should perform laparoscopic Whipple operation ?

Laparoscopic Whipple operation can be done safely in selected patients and by only a handful of trained surgeon in the world.

?The quick answer is: Those who have the skills as laparoscopic Whipple operation is technically VERY challenging...These are the surgeons not only has done lots of pancreatic surgery but also need to be fully trained in advanced laparoscopic surgery. Since laparoscopic fellowship training has only been around for about 5 years, therefore most of these surgeons are rather young.Therefore, if your surgeons is an old surgeons, make sure you do not let him/her talk you into letting him/her do the laparoscopic Whipple operation.

Where about in the USA can one get laparoscopic Whipple operation ?

In USA: There are only a few surgeons who has the skill set to complete laparoscopic Whipple operation.In Oregon: The available info that we have is as
follows:

http://www.peacehealth.org/Oregon/WhoWeAreSHMC.htm.





Variety of laparoscopic Whipple operation



1. Totally laparoscopic Whipple operation



In this approach, all the incisions are small, all the dissection and anastomosis are done by laparoscopic means.This is a technically much more challenging operations and therefore only a few trained advanced laparoscopic surgeons can complete these a totally laparoscopic Whipple operation



2. Hand assisted laparoscopic Whipple operation



In this approach, all the dissections are done laparoscopically. When it come to performing the anastomosis, the surgeon make a large open incisions ( much bigger than the totally laparoscopic Whipple operation, but smaller than the classic open whipple operation)




Potential advantage of laparoscopic Whipple operation.






Laparoscopic Whipple operations utilised several small incisions. Therefore, the advantages of laparoscopic Whipple operation will be:


1. Less perioperative pain
2. Early ambulation
3. Better return of full pulmonary functions
4. Less chances of developing DVT and pneumonia
5. Early return of bowel functions ( less narcotic use, early ambulation)
6. Lower incidence of incisional hernia






Potential disadvantages of laparoscopic Whipple operation


1. Longer operating time
2. More and earlier post-operative atelectasis.

Potential disadvantages of laproscopic Whipple operation that is likely not to be true

1. More bleeding
Surgeons that have done several of laparoscopic whipple operations showed that bleeding is not a problem, as they need to address bleeding, even in smaller amount as soon as possible, otherwise, their laparoscopic view will be affected)

2. Pooer oncologist outcome
This outcome of laparoscopic whipple or open whipple operation is likely going to be equal from oncology standpoint. There are minimal handling of the tumor during laparoscopic whipple operation, therefore tumor spread is minimised ( much so compare to open whipple operation)




Again..in experience hand, laparoscopic whipple can be done safely with good oncologic outcome




Controversy with laparoscopic Whipple operation.



Whipple operation is one of the most major abdomen operation. Whipple operation is associated with significantly high perioperative complications. Since Dr Whipple described this operation, this surgery has been done with a LARGE incision. Often time extend from the right side of the abdomen to the left side ( almost to the very edge). The complication rate of Whipple operation is approximately 30 to 40 %. The perioperative mortality rate range from 0 % to 10%, average about 5%.The controversy is what can a laparoscopic whipple operation improved these intrinsic complications.Nobody can provide patients with an answer yet. As there need to have more data on the outcome of laparoscopic whipple operation.However, just like most laparoscopic surgery, laparoscopic whipple operation has face many inersia of reluntancy.However, in selected hand, most advanced laparoscopic pancreatic surgeons suspect that the result of laparoscopic whipple operation is equal and non-inferior to open whipple operation.Certainly, we smaller incisions, post operative pain will be significantly improved.


Indication of Laparoscopic Whipple ( Laparoscopic Pancreatic Surgery)

Pancreatic Head Tumor:



1. Pancreatic adenocarcinoma ( tumor not involve the Portal Vein or Superior Mesenteric Vein)
2. Intraductal papillary mucinous neoplasm (IPMN)
3. Pancreatic Neuroendocrine tumor
4. Pancreatic cystic tumor (mucinous)
5. Chronic pancreatitis





Contra-indication for laparoscopic Whipple operation





In patients who had previous abdomen opeartion, any laparoscopic surgery may be more challenging due to scar tissue ( adhesion), therefore laparoscopic pancreatic surgery, including laparoscopic whipple operation may be a bit more difficult but not impossible





Laparoscopic Whipple operation in Oregon, USA





This is the info for laparoscopic whipple opeartion on Sacred Heart Medical Center web site home page athttp://www.peacehealth.org/Oregon/WhoWeAreSHMC.htm.