The expertise of the surgeons at the AdventHealth Digestive Institute Tampa (DI) is routinely sought out by other digestive health professionals. This past spring, Iswanto Sucandy, MD, FACS, advanced HPB (liver, pancreas and bile duct) surgeon, was invited to give multiple presentations related to DI’s expertise in minimally invasive, robotic liver surgery. He and his colleague, Sharona Ross, MD, FACS, an advanced HPB and foregut surgeon, are often asked to take part on expert panels at academic conferences and other events where medical professionals can earn continuing medical education (CME) credits.
Despite having a full surgery schedule, Dr. Sucandy accepted invitations to give talks at The Liver Week 2021 conference in South Korea, grand rounds at Abington – Jefferson Health, a hospital in suburban Philadelphia where Dr. Sucandy completed his residency in general surgery, and the 3rd World Congress of the International Laparoscopic Liver Society (ILLS), held virtually on June 12-13.
“I have to prepare and deliver three new talks within only a few weeks, like bum… bum… bum…,” mused Dr. Sucandy. Even though he is busy, he’s happy to give these presentations about robotic liver surgery because they might inspire other HPB surgeons to adopt an approach that can help more patients avoid open liver operations.
This first of a series of two blog posts will explore Dr. Sucandy’s talks at The Liver Week 2021 and at Abington – Jefferson Health grand rounds.
DI’s Good Outcomes Using Robotic Surgery for Major Liver Operations
On May 14, when Dr. Sucandy gave a presentation for an international conference – The Liver Week 2021 – based in South Korea. Because Seoul is 13 hours ahead of Tampa, he presented live and virtually in the wee hours of the morning. Speaking on “Institutional Experience and Clinical Outcomes of Robotic Major Hepatectomy for Liver Tumors,” Dr. Sucandy described the outcomes that their team have achieved by using the da Vinci® Surgical System to operate on liver tumors.
Dr. Sucandy pointed out that almost all of the medical literature about robotic liver surgery that has been published to date has been about operations that remove only a small part of the liver. However, some patients require large portions of the liver to be removed. For HBP surgeons like the ones at DI who complete high volumes of liver operations and have a lot of experience with robotic surgery, it is possible to perform major liver operations with the surgical robot.
“Our hypothesis is that the robotic system allows for safe and precise resection, which translates into a safe performance of a major hepatectomy,” Dr. Sucandy said during the presentation. In a layperson’s terms, the surgical robot gives surgeons the ability to remove parts of the liver very accurately even though it is not an open surgery. Having a closed operation also helps control bleeding during surgery. Patients lose much less blood than they would with open surgery. These factors add up to robotic liver surgery being very safe for patients.
To prove that robotic liver surgery is safe and effective, the DI surgeons analyzed 142 major liver operations they completed with the surgical robot from September 2016 through December 2020. They looked at factors including complications after surgery, how long each operation took, and how completely they removed all of the liver cancer tumors. Every 4 of 5 people in this group of patients had serious preexisting medical conditions that made them less than ideal surgical candidates. Their average age was 63 years, with many older than that. Even so, the surgeons determined that the robotic approach was associated with shorter hospital stays and fewer complications from surgery.
Dr. Sucandy concluded that, in the future, robotic surgery is likely to be used for even more complex liver procedures such as ones that require complex reconstruction of the bile ducts.
Minimally Invasive Surgery Advances for HPB Tumors Improve Patient Survival
For the Abington – Jefferson Health hospital grand rounds, Dr. Sucandy gave a long presentation about the latest minimally invasive surgery techniques for hepatopancreaticobiliary (HPB) tumors. He spoke about the surgical treatment approaches that the AdventHealth team uses for gallbladder cancer, pancreatic cancer, and liver tumors – both primary liver cancer as well as colorectal tumors that spread to the liver.
Dr. Sucandy spoke about how minimally invasive approaches – either laparoscopic or robotic – for liver cancer surgery are ideal when a surgeon has that expertise. The benefits of minimally invasive surgery are less blood loss, less pain, and smaller surgical incisions that are less prone to later injury or infection. Also, patients are able to eat and drink on the same day after their operations; that’s not the case with traditional, open liver surgery.
He also pointed out that his team are able to remove at least as much of the cancer tumor with a robotic surgery approach, and sometimes even more. That is because the da Vinci Surgical System’s 3D, high-resolution camera gives surgeons a better view of the operation. He cited a study published in the Annals of Surgical Oncology in 2017 that found that patients with primary liver cancer who had robotic surgery had better survival rates than those who had open liver surgery.
Almost 1 in 5 cases of colon and rectal cancer is diagnosed when the cancer has already spread to the liver. Dr. Sucandy talked about a new approach in which colon and rectal surgeons team up with HPB surgeons to complete two minimally invasive cancer operations at the same time: a colon resection and a liver resection. By having the cancer tumors removed from both the colon and the liver at the same time, patients only need to recover from one operation. This is an approach that Dr. Sucandy and Dr. Ross offer with their colon and rectal surgeon colleagues at DI: Allen Chudzinski, MD, FACS, FASCRS, Haane Massarotti, MD, FACS, FASCRS, and Gavin Sigle, MD, FACS, FASCRS.
In addition, Dr. Sucandy spoke about DI’s experience in using robotic surgery for pancreatic cancer. He pointed out that he and Dr. Ross have improved the outcomes for most of their patients who need pancreatic cancer surgery simply by using a robotic approach. In particular, patients who have robotic pancreatic surgery at DI experienced a much better average survival length. At least half of them lived for nearly three years after diagnosis compared to a year-and-a-half average survival for those who had open surgery.
Find out more about the benefits of minimally invasive surgery for a liver tumor or other digestive cancer. Call Call844-650-5950 to make an appointment with one of our advanced HPB surgeons.