- Associated Press - Saturday, January 6, 2018

COLUMBUS, Ohio (AP) - Daniel Brown just wanted to get off the phone and back to fishing.

Months earlier, doctors had found cancerous polyps during a colonoscopy, and then a pre-cancerous mass in his pancreas during a follow-up MRI.

But at that moment, Brown, 63, of Marion, was doing what he loved: angling for Lake Erie perch and walleye in Marblehead.

His surgeon interrupted the peacefulness at the lake to ask if Brown would agree to be the Arthur G. James Cancer Hospital’s first patient to undergo a robotic pancreatic surgery.

“I told him, ‘You will be the first, number one,’” surgical oncologist Dr. Carl Schmidt said. “I think he literally agreed to it because he wanted to get back to fishing.”

Brown remembered it the same way.

“I just told him: ‘Let’s just do it,’” he said. “‘I’ll be there.’”

So on Nov. 1, Brown underwent the first robotic Whipple procedure at the James at Ohio State University. The emerging surgical technique is meant to be less invasive than traditional surgery and results in reduced blood loss, smaller incisions with less scarring and faster recovery times.

The demanding Whipple procedure involves opening a patient and removing the head of the pancreas, part of the small intestine, the gallbladder and the bile duct. Then surgeons reattach the remaining organs so patients can digest food normally after the procedure.

“That part of a person is very complex. It’s one of the most technically challenging abdominal surgeries out there,” Schmidt said.

Brown’s surgeon, however, never laid a hand on him.

At a console a few feet from the operating table, Schmidt used hand controls to operate a $2.3 million, four-armed robot outfitted with surgical tools.

There are drawbacks to the futuristic approach.

Whereas surgeons traditionally depend on their hands to control bleeding, feel for rock-hard tumors and sense when a stitch has been pulled tightly enough, they lose that useful tactile feedback during robotic procedures.

The surgery time also extends to upwards of nine hours, and every operation requires coordinating a reservation for the costly machinery with a team of robot-savvy nurses and several certified surgeons.

“It’s a big investment, but we think it’s worth it,” said surgical oncologist Dr. Mary Dillhoff, who also operated on Brown.

The robot, in some ways, offers unprecedented advantages for surgeons.

Its arms are ambidextrous and can nimbly use tools in tight spaces and around corners.

Its “wrists” can rotate 360 degrees - a far greater range of motion than that afforded by human anatomy.

Magnification gives surgeons up-close, unparalleled views of ducts 1 millimeter in diameter.

“Even with microscopes on your face, what we see with robot vision is better. It’s extraordinarily strong,” Dillhoff said. “The view is beautiful. You can see every tiny little plane of tissue.”

For patients, robotic surgery involves a lower risk of infection, a reduced need for pain medication and shorter hospital stays, Schmidt said.

“Surgery at its core is destructive. It’s controlled injury. This technology developed to minimize the harms; that’s the ideal,” Schmidt said.

The world’s first robotic Whipple was performed in Italy in 2003.

Dillhoff said she hopes the James will soon perform half of its Whipples robotically.

But because of the James’ long history with robot-assisted surgery - beginning in 1999 - Dillhoff already reserves operating rooms with one of the hospital’s handful of robots months in advance.

Robotic surgery is performed at Ohio State University Wexner Medical Center’s University Hospital and East Hospital in addition to the James. The system is fast approaching its 15,000th robotic procedure, said Heidi Pieper, director of the Wexner’s robotic surgery program.

“Doctors’ attitudes changed,” she said. “Now, everybody wants in on it.”

Schmidt mastered the new method after a decade of performing Whipples through traditional open incisions.

“Operating becomes routine, which is good because we have to be as perfect as we can be,” he said. “This reinvigorated me.”

Theoretically, in the future, Schmidt said, robot-assisted surgery could lead to telemedicine, in which a surgeon in Asia could remotely operate on a patient in Europe, for example.

That possibility still seems beyond his career span, he said.

As for Brown, he and his wife, Cindy, credit the procedure for saving him from an essentially incurable disease. The one-year relative survival rate for pancreatic cancer is 20 percent, according to the American Cancer Society.

“It was scary, him being a guinea pig,” Cindy Brown said. “He has eight little holes, not even the size of a mosquito bite on his stomach - compared to the cut he would have had. I think it’s so amazing. If he hadn’t had that done, who knows the outcome?”

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Information from: The Columbus Dispatch, http://www.dispatch.com

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