St. Luke's doctors using robotic surgery to battle pancreatic cancer

New robot to help decrease 91% mortality rate

MILWAUKEE -- Doctors at St. Luke's Hospital are using a new technique in battling pancreatic cancer. They have started using a robot to perform the whipple surgery on pancreatic cancer patients.

"There are a few centers around the country doing this routinely," Dr. Wesley Papenfuss, surgical oncologist at Aurora Health Care said. "I think we're the first big center in Wisconsin to start doing this procedure. I think we have the ability to get ahead of the curve a little bit and adopt it."

Pancreatic Cancer has the highest mortality rate of all cancers. Seventy-four percent of patients die within a year of diagnosis and only eight percent live longer than five years. 

"Pancreas cancer is a very aggressive cancer," Papenfuss said. "Long term survivals are low. For that reason, we've taken a very aggressive approach at dealing with it including chemotherapy, radiation and ultimately surgery."

Traditionally, the whipple procedure was a very invasive surgery with a long recovery. It required a roughly 12 inch incision either from the breast bone to just below the belly button or a rainbow incision around the bottom of the rib cage.

"It's a long operation," Papenfuss said. "It's a technically demanding operation. Patients are often in the hospital for a week or two weeks in the ICU. Several days sometimes after that surgery. It's a lot to go through for anybody. Just when they're feeling well from chemotherapy, we bring them to the operating room and we put them through a big operation."

For Raul Escamilla, who was diagnosed with pancreatic cancer in December, the whole process has been exhausting. 

"My heart just dropped," said Escamilla, on how he handled learning his diagnosis. 

"It was very hard to take," Susie Escamilla, Raul's wife said. "We all got together and cried and then waited for the next step."

Escamilla was eligible for a more aggressive chemotherapy approach. It can take a toll on the body. So having an invasive surgery after can be difficult for a patient to come through.

Doctors approached Raul about the robot surgery as an alternative. 

"It was something new to me," Raul said. "I'm thinking about the old days where they cut your stomach but he stated, they're going to do the robot. I had no knowledge."

Instead of the one large incision, Dr. Papenfuss says the new surgery involves four to five small incisions, measuring about one centimeter each. In each of those incisions, the robot instruments are inserted. At the end of each robot arm are small, one to three centimeter clamps and cameras. The surgeon then sits in a large machine feet away from the patient. There is an area for the surgeon to look into the machine and see a three dimensional view of the inside of the body. Then, the surgeon has hand grips to operate the utensils inside the body. It looks remarkably similar to a virtual reality system where the hand movements are swiftly connected to what is happening on the screen. 

It's also less physically demanding on surgeons. Dr. Papenfuss sits comfortably as he works with the robotics. Before, he'd be hunched over a patient for hours which can have an impact on his back and arms. 

But while it's less physically demanding for him, it's the results from the patients he's more excited about. 

"They get up and moving quicker," Dr. Papenfuss said. "I think the quicker people get up and moving around after surgery, the less likely they're going to have problems with complications like blood clots and pneumonias. The quicker they're up and moving around, they get back to their normal life and they're more apt to get onto therapy a lot quicker."

For Raul, he recovered even more quickly than doctors expected.

"I felt real strong," Raul said. "Even in the ICU, even the nurses couldn't believe how I was reacting, sitting up the day after."

"I would have never believed this is how fast he came through this," Susie Escamilla said. "Almost like it didn't even happen, honestly."

Doctors kept Raul in the hospital for just five days. 

"He was looking to leave the hospital on day four after surgery," Dr. Papenfuss said. "His surgery and post-operative course went great."

While Raul's surgery was successful, he will need additional chemotherapy to keep his cancer from coming back. Doctors still feel good for his chances at a cure.

Mortality rates remain extremely low for pancreatic cancer patients. There isn't enough data to say if robotic surgery will have a significant impact on mortality rates, but doctors feel confident it is a step in the right direction. 

"I think pancreas cancer is still aggressive," Dr. Papenfuss said. "We still have a long way to go. I do think we're being very aggressive with it. I'm hopeful what we're doing is going to move that needle in survival."

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