Udupi: In a complex abdominal surgery, doctors at Kasturba Hospital, Manipal, successfully removed a pancreatic tumour from a 58-year-old woman using a combination of laparoscopic and robotic techniques. The patient was discharged seven days after the procedure.The patient had presented with yellowing of the eyes and skin, a symptom of obstructive jaundice caused by a tumour blocking the flow of bile from the liver. Scans revealed a bulky periampullary tumour, a cancer that develops where the bile duct and pancreatic duct open into the small intestine. The tumour had spread to the intestinal wall and the head of the pancreas.The surgery was further complicated by an anatomical variation in which one of the arteries supplying the liver followed an abnormal course directly through the surgical field, close to the tumour. Such a variation, seen in a small proportion of people, significantly increases the risk of bleeding and vascular injury during the procedure.To treat the cancer, the team performed a pancreaticoduodenectomy, commonly known as the Whipple procedure. It is one of the most technically demanding operations in abdominal surgery and involves removing the head of the pancreas, part of the small intestine, the bile duct and the gall bladder. The digestive tract is then meticulously reconstructed to restore the normal flow of food and digestive juices.The tumour was removed through small keyhole incisions, while the complex reconstruction was performed with the Hugo RAS robotic system. The system provides the surgeon with a magnified, three-dimensional view of the operating field and enables precise instrument movements with a greater range of motion than the human wrist.“Cases like this are technically very demanding, especially when an abnormal artery runs directly through the area being operated on, leaving very little margin for error,” said Dr Naveena Kumar AN, HoD of surgical oncology.The surgical team also included Dr Nawaz Usman, Dr Preethi S Shetty, Dr Akhil Palod and Dr Ananthakrishnan Balakrishnan, with support from the departments of anaesthesia and operation theatre staff.The procedure lasted around eight hours, with blood loss limited to approximately 200 ml. The patient recovered without major complications and was discharged on the seventh day. She remains under regular follow-up in accordance with standard cancer-care protocols.
