Surgeons at Monroe Carell Jr. Children’s Hospital at Vanderbilt, in collaboration with the adult robotic surgical team at Vanderbilt University Medical Center, performed the facility’s first robotic pancreaticoduodenectomy, also known as the Whipple procedure, on a pediatric patient.
The milestone surgery is among only three of these procedures reported for pediatric patients in the literature worldwide, according to the Monroe Carell surgical team. It’s one of the first in the U.S.
“And as more surgeons are being trained using robotics, it helps makes the case for us to be prepared to push the envelope in that surgical space. We are now being recognized as leaders on the forefront in pediatric robotic surgery.
Irving Zamora, MD, MPH
The patient, a 14-year-old girl, complained of abdominal pain after being hit in the stomach by a soccer ball and was diagnosed with a pancreatic head mass. The benign tumor required surgical removal but was in a precarious location.
Complex and rare in children
Faced with a rare diagnosis requiring a complex surgical treatment, Irving Zamora, MD, MPH, assistant professor of Pediatric Surgery and director of Advanced Minimally Invasive Surgery at Monroe Carell, believed the case was ideal for a robotic-assisted approach and reached out to his adult surgical colleagues for collaboration.
“Pancreatic head masses can be very complex and are rare in children,” said Zamora. “This patient was otherwise healthy and had a favorable benign pathology. Over the past five years, we developed a strong, minimally invasive and robotic surgical program at Monroe Carell. I felt our team was poised to take on this challenging case.
“This is a flagship case that highlights the complexity of the kind of advanced minimally invasive surgeries we are able to do at Monroe Carell. Performing these kinds of operations requires a high level of expertise. This is also demonstrative of the collaborative and innovative mentality of our team. We remain on the cutting edge to not only optimize outcomes for our patients, but to also continue partnering with our adult surgical colleagues.”
For decades, surgical procedures on the pancreas have been performed through an open incision, which can pose major risks for a child and lead to prolonged recovery. A minimally invasive operation often leads to a shorter hospitalization and swifter recovery for the patient.
Zamora credits Sekhar Padmanabhan, MD, assistant professor, Division of Surgical Oncology and Endocrine Surgery at VUMC with the ability to move forward with the groundbreaking surgical procedure.
“The Whipple is one of the bigger abdominal operations that we do,” said Padmanabhan. “It has a huge impact on a patient’s wellbeing and health. For a child who is growing and needs normal interaction with peers and school, getting them back to those things as soon as possible is just as important as the operation itself.
“Our pediatric patient was able to be discharged after only three days. That is more days for her to be at home with her family and return to her normal life of being a kid. That is the most important thing that we were able to do.”
‘A generational shift’
Padmanabhan, who is responsible for introducing the robotic Whipple operation to VUMC, came to Vanderbilt in 2021.
He began pursuing the robotic program in 2023, which continues to expand as awareness increases about the innovation and benefits of the surgical approach.
“In this case, at the end of the day, Dr. Zamora and I are two like-minded individuals with a desire to take our surgical care, our expertise in minimally invasive surgery, to the next level,” said Padmanabhan. “Collaboration is connecting groups with like-minded goals to care for patients. This was a huge team effort.”
Robotic procedures are seeing a generational shift, said the pair.
Increasingly residents are being trained using robotic interventions. There are only a select number of centers performing robotic Whipple surgeries, said Padmanabhan
“And as more surgeons are being trained using robotics, it helps makes the case for us to be prepared to push the envelope in that surgical space,” added Zamora. “We are now being recognized as leaders on the forefront in pediatric robotic surgery.
