Dr. David Kooby and Colleagues Perform Successful Robotic Pancreatectomies

March 2011

To date, two robotic pancreatectomies to treat pancreatic tumors have been performed at Emory with excellent results by Dr. David Kooby, who was assisted by fellow Emory surgical oncologist Dr. Shishir Maithel for one procedure and Emory urologist Dr. Kenneth Ogan for the other. It is not surprising that Dr. Kooby has adopted robotic  technology, as he has conducted notable prospective and retrospective assessments of open and laparoscopic methods of pancreas, liver, and biliary tract  resection, collaborating regularly with investigators at both Emory and around the country, and directed a national study of the efficacy of laparoscopic pancreatectomy from 2002-2006 that concluded that the procedure offered patients shorter hospital stays and fewer complications.

"For me," he says, "developing and making robotic pancreatectomy a common clinical practice at Emory was a logical progression."

A relatively young procedure that was first performed in 2007, robotic pancreatectomy provides a level of dexterity not possible with traditional laparoscopic instruments. Proponents of robotic surgery also believe this technology will come to provide even better patient outcomes and satisfaction than standard laparoscopy.

At Emory, Dr. Kooby and his colleagues use the da Vinci Surgical System, inserting its laparoscope and robotic arms through five small incisions in the patient's abdomen. They then view the operating field in 3-D at a surgical console, using computerized controls to precisely manipulate instruments with a 360-degree range of motion. The procedure culminates with the removal of the pancreas (with or without the spleen) through a two-inch incision.

The degree of accuracy the robotic method allows would be virtually impossible to replicate otherwise. The technology also makes it easier to preserve the spleen and greatly reduces the complexity of dissection and suturing.

"While we're certainly excited by the possibilities of the robotic technology, particularly in terms of patient recovery, we are also very concerned with comparing and determining the benefits of robotic versus laparoscopic pancreatectomy," says Dr. Kooby. "We will continue to evaluate the role of the robot in complex pancreatic operations, particularly since the technology appears to provide better dexterity, visualization and confidence in certain circumstances. Our hope is that we will be able to apply the technology to even more complex minimally invasive procedures as we move forward."