Robotic Whipple surgery excises intestinal tumor

The minimally invasive procedure has Emma Barros on track after her duodenal cancer diagnosis.

It wasn’t what Emma Barros envisioned for her 40th birthday, but considering all that she went through, she was just happy to be alive.

Ms. Barros, who immigrated to the US from Ecuador 20 years ago, planned to visit her native country for her big day. Instead, a litany of medical issues kept her in New York, where she celebrated the milestone with her family and clinicians at Long Island Jewish (LIJ) Medical Center on October 12. Diagnosed with duodenal cancer, Ms. Barros had a large tumor removed from her intestine via a complex robotic Whipple procedure.

“This being my 40th birthday, I wasn’t thinking of being here,” Ms. Barros said. “But this is the situation.”

Gallbladder removal

Ms. Barros’ situation started earlier this year when she returned from a trip to Ecuador. Persistent pain in her abdomen drove her to the doctor, who diagnosed her with gallstones. Ms. Barros had her gallbladder removed in March, but the pain returned. 

This time, with new symptoms.

“My body was itching all over,” she said. “I was getting jaundice. But I didn’t pay attention to it.

“My husband said ‘you look very yellow.” I didn’t believe him. Then, I asked my daughter. She said, ‘Mommy, you are yellow and need to go to the doctor.’”

Gary Deutsch, MD, and Emma Barros discuss the robotic Whipple procedure during her 40th birthday party at Long Island Jewish Medical Center.

A tumor in her duodenum

The next day, Ms. Barros went to the Emergency Department at LIJ Medical Center. She had an endoscopy, which revealed the cancerous tumor in her duodenum (the first part of her intestine). Before leaving the hospital, she had scheduled a visit with Gary Deutsch, MD, a surgical oncologist at LIJ.

“She was completely overwhelmed,” Dr. Deutsch said. “When you mention the C word, it hits you like a ton of bricks. It was the last thing on her mind. She thought she was having a stone removed. Little did she know she had cancer growing inside her intestine.”

What is a Whipple procedure?

Also known as a pancreaticoduodenectomy, a Whipple is a surgical option for a variety of tumors, including those in the bile duct, intestine and pancreas. Surgeons traditionally perform the Whipple with laparoscopic instruments. They remove the duodenum, the head of the pancreas and part of the stomach. They then reattach them to regain normal functioning of the intestinal tract.

“There are lymph nodes there, where the cancer can spread,” Dr. Deutsch said. “You have to remove those as well.

“The Whipple was first performed in 1935 and has come a long way since. We are doing things now that I don’t think the person invented it would’ve imagined.”

Very few health care organizations in the US offer the procedure robotically. But Northwell’s robotic surgery expertise gives patients more options. In fact, Dr. Deutsch has completed more than a hundred robotic procedures.

For Ms. Barros, the decision was simple.

“The reasons for using da Vinci [robotic surgical system] were many,” Dr. Deutsch said. “By operating robotically, we have better visualization with a high-definition 3D camera and more freedom of movement and dexterity. Also, such major abdominal surgeries traditionally resulted in longer incisions, more pain and scarring, and more recuperation time for the patient than da Vinci surgery.”

Dr. Deutsch completed the robotic procedure in seven and a half hours. And Ms. Barros had just five small incisions in her abdomen, as opposed to the large scar associated with traditional open Whipple surgery. She returned to her Brentwood home within a week.

Follow-up care

Dr. Deutsch said Ms. Barros is “ahead of where I expected her to be.” She’s eating small meals and is recovering. She will begin oral chemotherapy this week.

“The pathology came back very favorable and we are going to be very aggressive with her therapy,” Dr. Deutsch said.

Northwell Health is the first Robotic Surgery Network of Excellence designated by the Surgical Review Corporation.