The Whipple robotic procedure: A surgeon’s story to help pancreatic cancer patients

[10 MIN READ]

Key takeaways

  • Robotics is helping clinical experts perform complex medical procedures with greater precision.
  • Do the research to find the best surgeon to help address pancreatic cancer regardless of geography – a good health partner will get you the care you deserve no matter where you are.
  • Less invasive procedures using robotics can shorten the time it takes for patients to get back to their lives.  

Dr. Ahmad Abou Abbass, a surgeon at Providence Mission Hospital in Southern California, has a personal goal to help 50 patients diagnosed with pancreatic cancer using the Whipple procedure in 2021. With the aid of robotics, his goal may just be achievable. According to Dr. Abbass, using robotics to perform the highly complex Whipple procedure has the potential to revolutionize the treatment of pancreatic cancer.

To say that Dr. Abbass is an innovator is an understatement. With more than 800 roboticsurgeries under his belt ranging from liver to gallbladder and pancreas procedures, ten of which have been the Whipple procedure, he has become an expert in using new technologies to get patients back to life on their terms. “While the work I’m doing with robotic Whipple procedures can only help a small portion of patients with pancreatic cancer, I see the people I treat as part of my family,” said Dr. Abbass.

Human-centered care is in Dr. Abbass’ DNA, and he believes that patients diagnosed with pancreatic cancer deserve the best treatment possible. Furthermore, he encourages patients to conduct research to find the best surgeon to treat their unique needs regardless of geographic boundaries. In his own words: “I want people to know about my teams’ experience and growing expertise in fighting pancreatic cancer, and not be hesitant to make the trip to Orange County if it’s the right thing to do. If they need to come see me, we’ll find a way to make it happen together.” 

Before we get into Dr. Abbass’ story, it’s important to first provide some background on his field of specialty.    

What is the pancreas and why is it important?

Most people know the term pancreas, but what specifically does the pancreas do? At the most basic level, the pancreas is the organ that creates enzymes that break down sugars, fats and starches. It plays a two-part role in helping the body function. According to Healthline, the pancreas’ role in the endocrine and exocrine systems is broken down as follows:

  • Endocrine system: it secretes two main hormones – insulin and glucagon – that help to balance blood glucose levels. Finding this balance is important to proper functioning of the liver, kidneys and even the brain.
  • Exocrine system: it secretes enzymes into the digestive tract to break down substances such as fats and sugars. The secretion of these enzymes work with the liver and gallbladder to ensure proper digestion and absorption into the body.

A brief history of pancreatic cancer surgery

Surgeons dating back to the early 1900s have sought to find feasible ways to predict and treat pancreatic cancer. This field of medicine has been wrought with both significant wins and many setbacks throughout the years. Thanks to the advancements in technologies and committed surgeons building on the achievements of their predecessors, the focus on pancreatic cancer surgery has shifted from surviving the operation to surviving the cancer.

At a very basic level, a surgical procedure known as pancreatic resection, or “pancreatectomy,” removes cancer tumors from the pancreas. Dating back to 1882, Dr. Friedrich Trendelenburg demonstrated the feasibility of pancreatic resection that successfully removed a tumor from a patients’ pancreas. Surgeons the world over evolved procedures, and in 1934 a New York doctor named Allen Whipple invented a radical two-stage loop technique that removes the head of the cancerous pancreas, and a portion of the gallbladder, then reconnects the intestine, gallbladder and pancreas.  

The Whipple procedure

While pancreatic cancer affects 60,000 men and women in the United States, only about 20% of patients are eligible for the Whipple procedure. The Whipple procedure and other surgical interventions are typically relegated to patients where tumors are located at the head of the pancreas and have not metastasized beyond the pancreas. The image below offers an example of how the Whipple procedure can be used to redirect key organs. 

Also known as pancreaticoduodenectomy (PD), the Whipple procedure is one of the most challenging and complex procedures to treat pancreatic cancer. With a rich heritage dating back to the 19th century, the Whipple procedure has gone through a variety of iterations over the years. There are two main types of Whipple procedures – open and robotic.

  • Open: This traditional approach requires surgeons to make a large incision to remove tumors and reconstruct or tie together the pancreas, intestine and gallbladder.
  • Robotic: This is a minimally invasive approach that requires surgeons to make a few small incisions into which a camera and highly specialized instruments can be inserted to remove tumors and reconstruct affected organs.

As one would imagine, the traditional approach is much more traumatic to patients and requires a much longer recovery time. With the assistance of robotics, this surgical procedure is both much more precise and also leads to less trauma for patients, resulting in a faster recovery time.

Now, back to Dr. Abbass.

We sat down with Dr. Abbass to learn more about how Providence Mission Hospital is using robotics to treat pancreatic cancer. Below are some highlights from our conversation.

Q: Can you tell us about your experience in working with robotics and the Whipple procedure?

Dr. Abbaas: Surgery in general, robotics specifically, have always been a great interest for me. The precision enabled by using robotics helps increase the likelihood of positive patient outcomes. Moreover, having performed more than 800 robotic procedures throughout my career, I’ve become very comfortable and familiar with the technology. I have found that patients come out on the other side of surgery with less trauma and can get back to doing what they love doing more quickly.

Regarding the Whipple procedure, this is a highly specialized procedure, and the use of robotics has really been a game changer for my patients. Since 2018, I’ve preformed 10 robotic assisted Whipple procedures, and each time I’m more encouraged about the future prospects for how it can be used to help patients diagnosed with pancreatic cancer. For instance, while many robotics surgeries can take 10–12 hours, I’ve been able to reduce surgery time down to 4–5 hours, and I’ve realized these efficiencies while maintaining the highest bar of patient safety.

“I did a Whipple surgery on a patient on a Friday and when my partner checked in on the patient on Saturday they were walking around. I’ve never seen that before.”

As I’ve gotten more efficient with the robotic Whipple procedure, I realized that I need to start raising awareness and sharing my technique. Recently, I’ve started broadcasting live surgeries. During the last two procedures, I’ve had more than 15 surgeons from Europe, China, Dubai and various states across America tune into the live broadcast. This exposure, I hope, will both help surgeons and patients understand the advancements in treating pancreatic cancer that are possible.

Q: What was your journey into medicine, specifically the surgical field?

Dr. Abbass: I was always fascinated by science and knew from an early age that I wanted to be a doctor. I have always felt a calling to help people. Growing up in a small village in the Middle East where there were few doctors, I saw a need and it became my dream. It all became clear to me that being a surgeon was my future when I went to medical school.

During my time in medical school, I focused my time on surgical training, and did a lot of complex surgeries on the liver and pancreas. I then went to the Henry Ford Hospital in Detroit for a fellowship where I did transplant surgical training using traditional methodologies – meaning surgeries where I actually opened patients up. I often thought there had to be a more advanced way to do these surgeries.

I started researching the field of robotic surgery, and at the time it was the urology teams that were using these advanced techniques. When I finished my fellowship, I started talking to some of the surgeons using robotics. That’s when I started the next phase of my surgical career. I started out with small and relatively easy procedures, and as I got more comfortable, I moved into more complex surgeries using robotics, which culminated in developing an expertise in robotic assisted Whipple procedures.

Q: Why and how did you land at Providence Mission Hospital to practice and hone your craft in robotics surgery?

Dr. Abbass: My journey to Providence Mission truly happened by chance. In 2018, I decided to move to California for family reasons and I had a job lined up at a different hospital. Upon arrival there were some unexpected delays for me to start, and as luck would have it while I was at dinner with a colleague I learned of a great opportunity as head of surgery at Providence Mission Hospital and found that it was a better fit for where I wanted to take my career.

As to why Providence Mission, there are a variety of reasons. One of the key reasons I enjoy working at Providence is a commitment to technology. As mentioned earlier, the ability to use robotics that gives surgeons a 3D view magnified 10 times enables us to truly deliver precision medicine.

There’s also the compassion of caregivers across the organization. Patients are seen, heard and empowered; we see them as partners and people, and the relationship extends beyond the hospital doors. Then there’s also the leadership and collaboration elements. Doing what I do is bigger than the surgeon and requires ongoing support from the administration of medicine as well as collaboration with other specialists who are crucial for a multi-disciplinary approach to clinical excellence.

Q: Do you have a specific philosophy of care?

Dr. Abbass: I don’t see patients. I see people with a life; with a family and goals. It’s my job to work with them to get them well. My approach or philosophy is one of making sure the people I treat know that I’m here when they need me. All of my patients get my mobile number and I am available 24/7. Many of the people I treat send me pictures of birthday celebrations, and my texts are full of messages from current or past patients. I’ve become family with many of my patients and I am grateful to have the ability and opportunity to touch their lives.

Q: What’s the one thing you want patients to know about your work at Mission Hospital?

Dr. Abbass: When people first get the diagnosis of pancreatic cancer they get flooded with information and it can be confusing. Every cancer patient deserves the best care possible delivered with compassion. At Providence Mission Hospital, this is what we provide. So, I always encourage patients to do the research to find the best care available – whether that care is available in their community, in their state or out of state. Of course, I would like for them to consider Providence Mission, but I know that’s not always feasible.

“I want patients – wherever they are – to have faith that they would get world-class surgery for pancreatic cancer at Mission Hospital that they may not get at other systems and I have the data to prove it.”

Dr. Abbass is a passionate and experienced surgeon and his team at Providence Mission are ready to care for you and your family. We hope you found this capture of our conversation with him both inspirational and informative.

Learn more about the pancreatic and other cancer services offered at Providence Mission Hospital.

Related resources

Providence system cancer services

Dr. Walter Urba on immuno-oncology

World-class cancer care close to home

 

About the Author

Kelby has spent the last three-plus years leading the content strategy and editorial programming for Providence. His passion is finding the cultural insights that can be turned into relevant and helpful stories that will connect with people emotionally.

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