How robotic surgery is changing pancreatic treatment

Pancreatic surgery has long been considered among the most complex abdominal procedures, partly because the organ lies deep behind the stomach and close to major blood vessels.

Advances in minimally invasive and robotic-assisted surgery, however, are giving surgeons greater precision while helping suitable patients recover with less pain and fewer wound-related complications.

Consultant hepatobiliary, pancreatic and robotic surgeon Dr Bong Jan Jin said surgery may be required for cancerous or benign tumours, chronic inflammation such as pancreatitis, and injuries caused by accidents.

One common procedure is a distal pancreatectomy, which removes the body and tail of the pancreas. Depending on the disease and its location, the spleen may also need to be removed, although surgeons try to preserve it whenever possible because of its role in protecting the body against infection.

Traditional open surgery requires a large abdominal incision, which can lead to greater postoperative pain, a higher risk of wound infection and a longer recovery period.

Robotic surgery is performed through several small incisions, with the surgeon controlling robotic instruments from a console.

“The system provides a magnified three-dimensional view of the internal organs,” Bong told Bernama. “The robotic arms can move in ways that mimic the natural movement of the human wrist, allowing greater precision in a tight space.”

Patients who undergo robotic pancreatic surgery generally experience less pain and may require fewer strong painkillers than those having open surgery, he said. They may also begin moving sooner and regain bowel function more quickly.

If recovery is uncomplicated, discharge may be possible within seven to 10 days.

The smaller incisions can also make everyday activities easier to resume, although recovery times vary depending on the patient’s health, the extent of surgery and whether complications arise.

Not every patient is suitable for a robotic or laparoscopic procedure. The decision depends on the tumour’s size and location, as well as whether major blood vessels are involved.

Some pancreatic cancer patients may also receive chemotherapy before surgery. Known as neoadjuvant chemotherapy, this approach can help shrink a tumour and improve the likelihood of removing it completely in selected cases.

Will surgery cause diabetes?

One common concern is whether losing part of the pancreas will lead to diabetes. Bong said the risk depends largely on a patient’s health before surgery and how much pancreatic tissue is removed.

Those who already have diabetes may need stronger medication or more insulin after the procedure, while people with pre-diabetes may require closer monitoring.

For patients with no previous history of diabetes, removing about half of the pancreas does not automatically mean they will develop the condition.

“The remaining pancreas can often continue producing enough insulin and digestive enzymes,” he said.

Patients may nevertheless need time to adjust after surgery. Small, frequent meals are often recommended during the early recovery period, together with foods that are higher in protein and lower in fat and sugar.

This can help reduce strain on the digestive system while the remaining pancreas adapts.

With appropriate dietary guidance and follow-up care, Bong said most patients adjust well and return to their usual routines.

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