July 15, 2009
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This article appears in the July/August 2009 edition of HealthBeat, our bimonthly health newsletter.
Lois Bettis never thought it was a really big deal that she was the first person in Arizona to have one of the medical community's most complex general surgeries compliments of the da Vinci surgical robot.
"I was told they would attempt it with the robot," she said, "and if it didn't work the way they planned, they'd just open me up and do the surgery the traditional way. Frankly, I wasn't that focused on how the procedure would take place, but on the fact that I needed the procedure."
Roozbeh Rassadi, MD, general surgeon with Valley Surgical Clinics, and patient Lois Bettis.
A little more than 81 years of life experience, her strong faith and a positive attitude came together to leave Mrs. Bettis unworried. Her unruffled acceptance of her role as a surgical pioneer paid off — she came through the complicated procedure with flying colors. Days later, she was up and around.
Of course, her lifetime of healthy living, regular sessions of aerobics at the Chris-Town YMCA, good nutrition, a loving family and friends also contributed to her excellent outcome, following the kind of surgery her doctors describe as "one of the most complex and difficult procedures" in their repertoire.
Time-Tested 'Whipple' Procedure Goes 'Robotic'
The surgery is called the Whipple procedure, named after the American surgeon Allen Oldfather Whipple, MD. He devised a version of the surgery in 1935 and subsequently came up with multiple refinements to his technique.
The Whipple procedure is performed in rare instances when pancreatic cancer is diagnosed at an early stage. To illustrate the point, of the 1,000-plus procedures the surgeons from Valley Surgical Clinics perform each year, only 10 to 20 are Whipples.
The Whipple procedure is uncommon in part because pancreatic cancer is almost never symptomatic before it is terminal.
By the time it causes pain, it is usually too advanced for surgical treatment.
In Mrs. Bettis' case, however, her pancreatic tumor started growing right next to the bile duct from her gallbladder.
By blocking the bile duct, it caused jaundice, an unusual but — for Lois Bettis — an extremely fortuitous event.
Jaundice Led to Early Detection of Cancer
Francisco Rodriguez, MD, operates using the da Vinci robot.
"This brought Mrs. Bettis into the hospital for testing and subsequent surgery," said Francisco Rodriguez, MD, senior partner of Valley Surgical Clinics. He and his partner, Roozbeh Rassadi, MD, performed Mrs. Bettis' procedure with the $2 million da Vinci surgical robot at John C. Lincoln North Mountain Hospital.
"If the tumor hadn't been exactly where it caused jaundice," Dr. Rodriguez said, "the cancer could have grown to a much more dangerous stage before it was discovered. As it was, the jaundice probably saved Mrs. Bettis' life."
"I had noticed my skin was a little yellow right before I was planning to meet my high school friends in Laguna Beach for our annual get-together," she recalled.
"I didn't know what it was but I felt fine, so I made an appointment to see my doctor when I got back. I'm glad I didn't know ahead of time what was wrong, because it would have ruined my California vacation."
As it was, she thoroughly enjoyed her week at the beach, and when she returned to Phoenix she saw her family doctor, who ordered some tests that showed a large, olive-sized tumor on her pancreas. She was referred to board-certified gastroenterologist Stephen Glouberman, MD, who admitted Mrs. Bettis to John C. Lincoln North Mountain Hospital for further medical testing.
Dr. Glouberman notified the surgeon on call from Valley Surgical Clinics. That turned out to be Dr. Rassadi.
"Dr. Rassadi was very helpful in explaining what was going on. He took a great deal of time to make sure I, as well as my kids, understood what I was facing."
Whipple Procedure Typically "Very Complex and High Risk"
During the Whipple procedure, the head and sometimes the central body of the pancreas is removed, along with the lower part of the stomach, the stomach bile duct, the duodenum, the gallbladder, part of the middle section of the small intestine and the lymph nodes near the pancreas.
Then the remaining tail of the pancreas, the remaining portion of the stomach and the remaining bile duct from the liver are reattached to the small intestine.
Traditionally done as open surgery, "this is a very complex and high-risk procedure," Dr. Rodriguez said.
This was the first time in Arizona that the da Vinci had been used to perform a Whipple procedure. But as one of Arizona's most experienced general surgeons with robotic surgical procedures, Dr. Rodriguez was confident they could successfully complete Mrs. Bettis' Whipple with the da Vinci.
To perform robotic procedures, the surgeon sits at a console and directs the da Vinci's laparoscopic surgical tools with fingertip controls that provide enhanced dexterity and safety. Instead of viewing his work on a flat video screen, he sees a full-color, 3-D, high-definition image that has been magnified 10 times.
After the procedure, Mrs. Bettis had an uncomplicated recovery, "I really wasn't in pain after the surgery," she said, "just what I guess you would expect from an extensive abdominal surgery."
Despite the fact that 14 lymph nodes showed no sign of cancer, because pancreatic cancer is one that commonly shows up in other parts of the body, Mrs. Bettis has agreed to four cycles of chemotherapy. "By the end of July, that'll be the end of it," Mrs. Bettis said with a smile.
Then it will be back to normal life — cooking for the New Day Center sponsored by the United Methodist Church, sewing for the back-to-school clothing drive and playing handbells at her church. She's looking forward to time with family and the annual gathering with her high school friends in Laguna Beach for many more years.
Visit JCL.com/scarlesssurgery for more information.
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