High-tech Teamwork

UF Health’s first fully robotic Whipple procedure provides hope

High-tech Teamwork

UF Health’s first fully robotic Whipple procedure provides hope

By Natalie Spindle

Maureen Stowell and her husband, Richard, reside in the quiet Florida town of Ormond Beach, where she enjoys spending time with her sons and grandchildren.

If she is not in the kitchen baking, you can often find her in the garden tending to her fruits and vegetables.

After retiring as an apprenticeship representative for Flagler County Public Schools, Stowell got a part-time job in retail. When she began to experience fatigue and lost 35 pounds, she wrote it off as a side effect of her new job.

However, her body began to tell her that something was wrong with her digestion, so she sought an exam from her doctor in Port Orange.

A few tests and an endoscopy, or nonsurgical procedure used to view the digestive tract, revealed Stowell had ampullary cancer. This type of cancer is found
in a very small section of the bile duct.

Stowell’s doctor was quick to recommend surgery to remove the tumor and treat her cancer.

“What kind of surgeon do you want?” her doctor asked. “Good or the best?” Naturally, she said “the best!” Her doctor then referred her to Ziad Awad, M.D., the
medical director of minimally invasive surgery at UF Health Jacksonville.

Upon first examination, Awad recommended the Whipple procedure.

For UF Health and Awad, the fully robotic Whipple was a first. It is one of only a few surgeries of its kind performed in the state.

The robotic Whipple is the most minimally invasive of the options for the procedure and results in less blood loss, a shorter hospital stay, quicker recovery time
and fewer complications.

Maureen Stowell and her husband, Richard, enjoying a sunset on a trip to Hawaii

Maureen Stowell and her husband, Richard,
enjoying a sunset on a trip to Hawaii

“Only around 30% of ampullary cancer patients qualify for the Whipple due to the size and location of the tumors,” Awad said. “Stowell was an ideal candidate; the cancer was caught early and the anatomy was favorable for this method.” The Whipple First introduced in 1935 by Allen Oldfather Whipple, M.D., the procedure is considered the most promising surgical option for patients diagnosed with pancreatic cancer located in the head of the pancreas. It is a surgery in which the head of the pancreas, gallbladder, bile duct, and parts of the stomach and small intestine are removed. The organs are later reconnected to allow for normal digestion again.

“Performing the first robotic Whipple at UF Health is a significant accomplishment for Dr. Awad and his team,” said Scott Lind, M.D., a surgeon at UF Health Jacksonville.

“The Whipple procedure is perhaps the most complex operation performed by oncologic surgeons and it requires a highly skilled surgeon and operative team.”

Because of the surgical expertise required, the American Cancer Society recommends having the surgery performed by an experienced surgeon in a
hospital that accommodates at least 15 to 20 Whipple procedures every year. Awad performs about 40 each year to treat pancreatic cancer, pancreatitis and
neuroendocrine tumors.

The Surgery

Awad and his team use the da Vinci Xi, an advanced surgical system that features robotic arms and allows for greater stability. The surgeon is in complete
control of the da Vinci and guides the surgical instruments by watching the area on high-definition monitors.

With instruments that provide better dexterity and range of motion than the human hand, Awad maintains greater control and precision than found in
traditional open operations and some laparoscopic procedures. The true advantage of robotics, according to Awad, is the improved ergonomics that help decrease the impact of fatigue on the surgeon.

“The nimble movements, 3D visualization and ease of suturing with robotics are unmatched,” Awad said. “The medical field is moving toward the use of
robotics to improve patient outcomes.”

During the procedure, Awad removed Stowell’s bile duct, duodenum, gallbladder, head of the pancreas and two inches of her stomach. The team then completed three reconstructions to reattach the remaining organs and allow for normal digestion.

“I credit teamwork for the phenomenal outcome of this surgery,” Awad said.

The six-hour procedure required coordination among two surgeons and two anesthesiologists, along with two anesthesia technicians and other operating
room personnel.

“The care I received was excellent. The entire staff was wonderful to me,” Stowell said. “When I left the hospital, I saw a double rainbow and I knew everything
would be OK.”

The procedure went extremely well and — as a result of the minimally invasive, robotic approach — Stowell experienced less pain and a shorter hospital stay than a standard open procedure.

“Patients who undergo this complex oncologic operation also receive state-ofthe- art postoperative care by our surgical critical care team,” Lind said. “The technical expertise of the surgeon and the care delivered in the perioperative period are critical to optimize patient outcomes.”

Stowell looks forward to continued healing and good health. Other than a few dietary restrictions, she has returned to her usual schedule.

She looks forward to resuming her gardening and spending time with loved ones.

Maureen Stowell and her husband, Richard, enjoying a sunset on a trip to Hawaii.