Pancreatoscopy

The management of potentially malignant pancreatic cysts has evolved significantly over the previous decades. Previous approaches focused on operations for any detected cysts has made way for a more comprehensive approach characterizing the underlying risk in which a patient's specific cyst may have. This concept also applies to patients undergoing surgery for main duct cystic disease of the pancreas. While previously managed in large part by removal of the entire pancreas, new approaches that incorporate intraoperative evaluation of the pancreatic duct through advanced imaging technologies are becoming more common.

At Johns Hopkins, we have collaborated with many of the world's highest volume centers to evaluate the utilization of a small, catheter-based, video platform that allows for inspection of the internal aspects of main duct cystic disease of the pancreas. In this nonrandomized trial, surgeons at Johns Hopkins utilize a pancreaticoscope to view the duct, characterize risk for malignancy and biopsy of abnormalities when performing a partial pancreatectomy for a potentially malignant disease.

Robotic Surgery Versus Open Whipple Trial

Pancreaticoduodenectomy is performed for many reasons, including several types of cancer of the pancreas, as well as pre-cancer conditions. Pancreaticoduodenectomy can be performed through the traditional open procedure (large incision) or a robotic approach (using small incisions and a camera with a surgical robot). Utilization of the robotic system may result in favorable oncologic and safety outcomes compared with other minimally invasive approaches. Whether robotic pancreaticoduodenectomy in the hands of high-volume pancreatic surgeons is a safe and effective procedure has not been addressed prospectively. The purpose of this clinical study is to compare two types of surgery for removal of the head of the pancreas and surrounding structures: robotic pancreaticoduodenectomy (performed with the assistance of a robot device through several small incisions) and open pancreaticoduodenectomy (standard surgery with one large incision). Both methods are routinely used at Johns Hopkins but there is limited information about which surgery type helps patients recover faster and has fewer complications.