One key treatment option is the Whipple procedure, a complex surgery that removes the head of the pancreas. There are three approaches to this challenging surgery: open, laparoscopic and robotic.

Dr. Michael Kendrick, a hepatobiliary and pancreas surgeon at Mayo Clinic, specializes in the laparoscopic Whipple procedure. He says, depending on the location and stage, patients may need to undergo extensive treatment before surgery. This makes the minimally invasive laparoscopic approach easier on the patient.

Watch: Laparoscopic Whipple procedure

Journalists: Broadcast-quality video (1:16) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"At this point, surgery is the only potentially curative treatment," says Dr. Kendrick.

However, for the best outcome, most patients with pancreatic cancer will need chemotherapy and radiation before surgery to maximize cancer outcomes. Dr. Kendrick says that after such rigorous treatments prior to surgery, minimally invasive approaches help minimize the effect on the patient's health.

"It's much less stress on the body than the open approach, and so most of the studies show that patients have less pain, quicker recovery, less blood loss and shorter hospital stays, which has been very beneficial," he says.

Laparoscopic means making small incisions and using a camera and special instruments that traverse the abdominal wall to perform the operation internally.

"The surgeon's right at the bedside, holding and controlling all of these instruments," says Dr. Kendrick.

After the operation, the patient wakes up with bandages rather than a large incision. These small incisions mean less pain from the operation and quicker healing time. 

"The minimally invasive approach is allowing people to recover quicker, which gives them more hope that after all of the treatment they've gone through  — the chemotherapy, the radiation, now the surgery — that finally they're going to get some of their life back. And I think that's really rewarding," Dr. Kendrick says.

Mayo Clinic is a leader in the minimally invasive laparoscopic approach to the Whipple procedure and is one of the few medical centers offering it. Dr. Kendrick says it's important for patients to ask questions about their treatment options and get a second opinion to ensure they are getting the best possible treatment.

Related posts:

• Mayo Clinic Minute: Detecting pancreatic cancer
• Detecting pancreatic cancer through changes in body composition and metabolism

The post (VIDEO) Laparoscopic Whipple procedure for pancreatic cancer appeared first on Mayo Clinic News Network.

The COVID-19 pandemic forced elective surgeries to be delayed while hospitals prepared for the potential influx of COVID-19 patients. Thanks to effective efforts to flatten the curve and the lifting of executive stay-at-home orders, Mayo Clinic is again able to see patients for elective surgeries. What’s different for patients when having surgery during the coronavirus era? And what extra steps is Mayo Clinic taking to keep patients and staff safe? 

On the Mayo Clinic Q&A podcast, Dr. Michael Kendrick, chair of the Department of Surgery at Mayo Clinic, explains how surgical practice remains safe in the time of COVID-19.

Mayo Clinic Q&A is available on podcast platforms including Apple, Google, Spotify, Stitcher, TuneIn and iHeart. 

_________________________________________________________

For the latest updates on the COVID-19 pandemic, check the Centers for Disease Control and Prevention website. For more information and COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

The post Mayo Clinic Q&A podcast: Surgical practice during COVID-19 appeared first on Mayo Clinic News Network.

A lifetime of food addiction resulted in Jessica Erickson's weight becoming unmanageable. When she looked for medical help, she found a Mayo Clinic team that offered her the care and support she needed to become a smaller, healthier version of herself.

When Jessica Erickson walks up the stairs these days, the only thing she worries about is whether her fitness tracker accurately records all the flights she climbs. It's a dramatic shift from three years ago when Jessica weighed more than 400 pounds and couldn't climb one flight of stairs, much less the 12 she now strives for each day.

After an innovative bariatric surgery at Mayo Clinic in October 2016, Jessica lost more than half her body weight. She now weighs about 168 pounds. But getting to a point where she could achieve that success took a long time. Jessica resisted weight-loss surgery and put it off for years.

"There is a stigma attached to patients who've had bariatric surgery — that it's the easy way out," Jessica says.

It wasn't until Jessica accepted that the surgery was treatment to manage a medical condition that she agreed to the seldom-performed operation known as a biliopancreatic diversion with duodenal switch.

"Bariatric surgery is never a shortcut," says Jessica, who lives in Red Wing, Minnesota. "It's a tool that you're given that will help you in the process. That's all it is. Bariatric surgery provides you with a tool."

Encouraged by a multidisciplinary Mayo care team who supported her through her weight loss, Jessica has lost and kept off 250 pounds for nearly two years.

"Weight is no longer a number for me. It's more about being healthy, and being able to move around and do the things I want to do," Jessica says. "I know, without a doubt, that if I remain healthy, I've got a longer life than I would have before. I honestly believe that these doctors saved my life."

Reaching out for help

Jessica battled obesity her entire life. She tried dozens of weight-loss strategies. On three separate occasions, she lost and gained back 150 pounds. But it wasn't until her weight began preventing her from interacting with others that Jessica decided she needed help.

"I'm a very social person," she says. "I love talking, and I was noticing — particularly at my son's basketball tournaments — that I was always waiting and looking for a place to sit, and not looking at my son's games."

During one game, Jessica had an epiphany. "I thought, 'Is this what I want to do — spend the rest of my life looking for a place to sit down and not engaging with people around me?'"

"At the appointment, [Dr. Radtke] asked me why I was there, and I said, 'I have to do something, or I'm going to die.'"

Jessica Erickson

After that, Jessica met with Jennifer Radtke, M.D., a primary care physician at Mayo Clinic Health System in Red Wing. "At the appointment, she asked me why I was there, and I said, 'I have to do something, or I'm going to die,'" Jessica recalls.

Dr. Radtke agreed that Jessica's weight posed a serious risk to her health. She recommended Jessica visit a specialist at Mayo Clinic's Rochester campus for targeted weight-loss therapy.

In Mayo Clinic's Department of Endocrinology, Jessica met Kurt Kennel, M.D. During their first meeting, Jessica learned she was too heavy to qualify for a sleeve gastrectomy. Sleeve gatrectomies, which accounted for 60 percent of all bariatric procedures performed in the U.S. in 2017, can help patients lose approximately 50 percent of their excess body weight, Dr. Kennel says.

"For Jessica, even if she lost half of her extra weight, she would still have been overweight," Dr. Kennel says.

With a duodenal switch procedure, patients can lose 70 to 80 percent of their excess weight, Dr. Kennel explains. "The switch has always been specialized for certain situations, and typically those are very heavy patients," he says.

During the operation, a patient's stomach is refashioned into a small tube. In addition, a patient's digestive structures are rearranged, so digestive bile from the pancreas doesn't encounter food in the small intestine until the end of the tract. As a result, only a small percent of what a patient eats is absorbed.

Learning she'd require more extreme measures to achieve her goal gave Jessica pause. "I agreed that we would start the 12 weeks of classes required before the surgery, and halfway through it, I would decide," she says.

Changing diet and mindset

In May 2016, when Jessica began the behavioral health education course required before surgery, she altered her diet to better align with the diet she'd need after surgery. She began by reducing carbohydrates — first making small changes and then larger ones.

"I focused on a style of eating better," she says. "I cut back on calories to under 1,000 a day, which is the where I'd need to be if I went through the procedure."

In addition to a change in diet, Jessica began exercising. "I started by walking around the block," she says. "I would go one length and have to stop and rest. I had no strength and endurance. I started doing anything I could do to get in any exercise, even if it was just doing arm circles at the table — anything I could do to try to increase my caloric burn."

By the time Jessica was near the end of her 12-week course, she'd lost 75 pounds. "I was at the point to where people were saying, 'If you've lost that much, you really don't need to have surgery,'" Jessica says. "But it was at that point I was starting to stumble. That's when you start cheating, deciding you don't need to exercise that day."

Jessica had two moments of clarity that convinced her to continue toward surgery. The first was when she noticed she could stand for longer than five minutes. "The second one was a week and a half before my surgery when I realized that I was going to gain that 75 pounds back if I didn't have the surgery," Jessica says. "It was given. I was going down the same path as before, and it was in that realization that I knew I'd made the right decision."

Shifting weight and outlook

Mayo Clinic surgeon Michael Kendrick, M.D., performed the two-phase procedure on Jessica on Oct.18, 2016. The first few weeks after her operation, the weight lost was mainly surgery-acquired water weight. Around Christmas, Jessica's new anatomy began working for her, and she started shedding pounds.

Some weeks she lost three pounds. Other weeks, she lost six. Over the course of a month, 20 pounds might come off. Jessica, who is 5 feet, 8 inches tall, set her goal weight at 185 pounds. In August 2017 — a month she lost 16 pounds — it became clear Jessica needed to slow her weight loss. Jessica began to incorporate more fruit and the occasional sweet treat into her diet. In September, she lost eight pounds. By the October anniversary of her surgery, she was at her goal weight. Since reaching her goal weight, Jessica has increased her daily caloric intake to about 2,000.

Although Jessica had lost nearly 250 pounds of fat, she continued to struggle with the effects of her obesity. In spring 2018, she had surgery, performed by Mayo Clinic plastic surgeon Basel Sharaf, M.D., D.D.S., to remove excess skin from her abdomen and breasts. An additional surgery to remove excess skin under her arms is planned, as well.

"This whole process is about healing me, making me healthier and making me more of the person who I am."

Jessica Erickson

For most patients undergoing this transformation, plastic surgery is an important part of the process, Dr. Sharaf says. "The excess skin can have implications for their health, due to skin infections or interference with their activities of daily living, exercising and staying healthy."

What's more, the negative body image held by many patients after weight-loss surgery can have psychological implications on their overall well-being. Improving that self-image is an integral component of the patient's journey to physical and mental health, Dr. Sharaf adds.

"This whole process is about healing me, making me healthier and making me more of the person who I am," Jessica says. "Dr. Sharaf is helping me become the 'me' that I've been waiting for years to be."

Realizing goals and reaping rewards

Despite reaching her goal weight, Jessica still has moments when she loses touch with her current appearance. "When you lose a lot of weight, it's hard to really understand where you are in size in relation to the rest of the world," Jessica says. "Body dysmorphia is when you brain doesn't allow you to see how you really are. My brain has not completely adjusted, but I am much better than I was."

From the start of her process, it was clear to Dr. Kennel that Jessica was fully committed to losing the weight.

"She was a person who had a goal in mind and very much wanted to do it the right way," he says. "She was fully embracing the process — and it can be a long process. Even before surgery, she was showing herself to be capable and committed, and doing things that make you think, 'Yeah, this person is probably going to do very well.'"

In addition to being lighter, Jessica's weight loss has resulted in the resolution of weight-related health issues such as high blood pressure, high cholesterol and high blood sugar. Jessica's sleep apnea also disappeared.

The appreciation Jessica has for the medical team that supported and facilitated her new appearance, good health and fresh outlook cannot be overstated, she says.

"Never did I feel in any way like I was being judged in a harsh way," Jessica says. "They have always been there to answer questions and be helpful, and encourage and point me in the right direction. It's such an inspiration for me to see them changing people's lives. Not just mine, but so many people out there. I'm just incredibly grateful for everyone out there."

HELPFUL LINKS

• Learn more about bariatric surgery.
• Visit the Department of Endocrinology.
• Connect with others talking about healthy living on Mayo Clinic Connect
• Explore Mayo Clinic.
• Request an appointment.

The post Less Is More: Losing Weight, Gaining Perspective appeared first on Mayo Clinic News Network.

When she was 38, Radhika Sattanathan received a frightening diagnosis of pancreatic cancer. Taking the advice of her physician in India, Radhika sought care halfway around the globe at Mayo Clinic. Today, she's cancer-free.

Radhika Sattanathan was a young mother and wife living in Mumbai, India, when abdominal symptoms first struck her seven years ago. A sharp, sudden pain was accompanied by hours of severe vomiting. The episode sent Radhika to a local emergency department, where she learned she had acute pancreatitis.

Radhika spent nearly two weeks in the hospital receiving treatment. Her hospitalization marked the beginning of a medical journey that lasted for years and led Radhika through a diagnosis of pancreatic cancer and, ultimately, to Mayo Clinic for pioneering treatment.

Today, Radhika is cancer-free. She attributes her good health to the support of her husband, Suresh Mahadevan, and her medical team, which included both Indian and American gastroenterologists and oncologists.

"We see many patients with pancreatic cancer who were told that their tumor is not removable and are given palliative therapy or just sent home to die," says Michael Kendrick, M.D., of Mayo Clinic's Department of Surgery. "It is very rewarding to tell patients that there is hope. While pancreatic cancer is still a difficult cancer to treat, and recurrence is common, we are making great strides. We definitely cure some and improve the quality of life and duration of life in many others."

Santhi Swaroop Vege, M.D., a Mayo Clinic gastroenterologist who collaborates with Radhika’s physician in India, says several factors contributed to Radhika’s success.

"I think one could say she probably survived because the diagnosis was made early, and the surgery was done laparoscopically, so she was able to receive the chemotherapy more quickly after surgery," Dr. Vege says. "All the planets aligned for her."

Severe situation

When Radhika had her first bout of pancreatitis in July 2011, she was 34 years old and had a 1-month-old infant. For the next two years, the disease and its symptoms — abdominal and back pain, nausea, vomiting, and fever — wreaked havoc on Radhika’s life.

In and out of the hospital 10 times in the first year alone, Radhika saw her condition improve only after she learned that fatty foods could be triggering flare-ups. By changing her diet, Radhika began managing her condition. Her frequency of hospitalizations decreased, and she learned the steps required to minimize flare-ups.

"In summer of 2013, we moved to Singapore. For two years, everything was fine," Radhika says. "I knew how to manage my body. When I started feeling the symptoms of pancreatitis, I fasted — not even consuming water — for a couple of days till the symptoms subsided."

"My husband asked the doctor what he would do, and the doctor said he would go to Mayo Clinic."

Radhika Sattanathan

But in 2015, Radhika experienced a type of abdominal pain that was new. It came on slowly and didn’t intensify when she ate or drank. Radhika soon learned it wasn't the pancreatitis. This pain was caused by a cancerous growth that had taken root in her pancreas.

Radhika consulted with her gastroenterologist in India, and she learned that her cancer required immediate surgery. He presented Radhika with three treatment options for the operation, known as the Whipple procedure. She could have the conventional, open abdominal surgery in India, receive that same surgery in Singapore, or travel to the U.S. and receive the surgery laparoscopically at Mayo Clinic.

"My husband asked the doctor what he would do, and the doctor said he would go to Mayo Clinic," Radhika says.

Less than a week later, in September 2015, Radhika and Suresh were at Mayo Clinic's Rochester campus, where Radhika was admitted to the hospital.

Tough therapy

Although Radhika’s Mayo Clinic medical team was eager to move forward with her treatment, imaging revealed that not only was the tumor large, but Radhika also had developed a blood clot in a vessel near the pancreas. The clot needed to be treated before Dr. Kendrick could perform the operation. Radhika was put on blood thinners and informed that she would need to begin chemotherapy immediately.

Radhika opted to return to Singapore for four rounds of chemotherapy. The medicine, called Folfirinox, was administered over the course of three days every 15 days. Folfirinox, says Dr. Kendrick, is among the newer chemotherapy agents used for pancreatic cancer and can be more difficult to tolerate than other drugs.

"The benefit is that it’s harder on cancer cells," Dr. Kendrick says. "So that’s why we’re seeing these remarkable responses."

Radhika recalls that the side effects of the chemotherapy were tough to take.

"For the first two days after the treatment, my tongue would go numb, and I couldn’t speak," she says. "The tastes on my tongue also went away. My body would become very stiff. I needed help to even go to the bathroom. When I washed my hands, I felt a painful, needle-poking sensation. I could not touch anything even mildly cold. I felt dizzy. I had cramps, stomach pains, vomiting, constipation, hair loss, loose stools."

In addition, Radhika’s bone marrow production slowed during her chemotherapy sessions, and her blood counts dropped. Radhika’s blood sugar levels also increased, and she required insulin shots. The first time Radhika’s parents saw her during the chemotherapy treatments, they were extremely concerned by the side effects their daughter was experiencing.

"My husband was so supportive. He told my parents not to worry," Radhika says. "He never gave up on me. He fought for me. He kept saying, 'Nothing will happen to you.'"

In December, as soon as Radhika could travel after completing her last round of chemotherapy, she and Suresh flew back to Minnesota, where she had more imaging at Mayo Clinic. The new scans revealed the tumor had decreased in size but still involved major blood vessels. Radhika’s team recommended radiation therapy as the next step.

"We were like: 'What is this? It’s the second time we’re here, and the surgery is not happening,'" Radhika says. "So we flew back to Singapore again and started doing radiation."

In addition to receiving radiation therapy, Radhika received more chemotherapy in early 2016. When the treatment was complete, Radhika’s medical team regrouped and began discussing surgery once more.

"This time, before coming, we did CT scans and sent them to Dr. Kendrick," Radhika says. "He said everything looked fine and fixed the surgery date for April 12."

Innovative operation

Radhika's surgery at Mayo Clinic involved removing one-third of her pancreas, the bile duct, the gall bladder, and the duodenum, or top part of her small intestine.

"The organs are removed, and then we use the intestine to hook everything back together," Dr. Kendrick says.

Traditionally, the Whipple procedure involves making a large incision through the abdominal wall to remove the organs and restructure a patient’s anatomy. Recovery time can range from weeks to months. Although it’s still major surgery, performing the procedure laparoscopically eases recovery significantly.

"The patient has six tiny incisions, about one-half inch in size, and they have almost no pain," Dr. Kendrick says. "Patients are walking the next day, and many are out of the hospital in five days."

In Radhika’s case, the cancer was removed, as were several lymph nodes. Although she still required follow-up treatment to make sure all cancer cells were eliminated, the surgery was a success.

"Everything went really well for her," Dr. Kendrick says. "Mayo Clinic is a world leader with this kind of surgery. We have the most experience and have advanced the technique in many ways, including use for patients with advanced pancreatic cancer."

"She really is one of these cases where she’s living and very happy, and we hope she will do well for a long time."

Santhi Swaroop Vege, M.D.

Radhika was discharged from the hospital five days after surgery. For the next month, she stayed with family members in Iowa. At her one-month follow-up appointment, Radhika was cleared to go home.

Back in Singapore, Radhika had additional chemotherapy treatments. With all her treatment now complete, Radhika checks in with her physicians every three months for blood tests and imaging exams to monitor her condition. Looking back, Radhika is amazed she came through her cancer treatment as well as she did.

"I used to give up. I cannot tolerate pain at all, and every time they used to poke me, I used to cry and cry and would say, 'I’m done,'" Radhika says. "Somehow I came out of all of that."

For as difficult as her journey was, the outcome is remarkable, Radhika’s physicians say.

"We were aggressive because of her young age," Dr. Vege says. "Today there is no evidence of cancer. Her CT scans are normal. She really is one of these cases where she’s living and very happy, and we hope she will do well for a long time."

HELPFUL LINKS

• Read more about pancreatic cancer.
• Learn about Mayo Clinic's approach to the Whipple procedure.
• Check out the services for international patients at Mayo Clinic.
• Explore Mayo Clinic's Rochester campus.
• Request an appointment.

The post Subduing Pancreatic Cancer Involves International Odyssey appeared first on Mayo Clinic News Network.

Here's the Mayo Clinic Radio podcast.

The post Smoking Cessation / Cochlear Implants / Laparoscopic Pancreatic Surgery: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Listen to the program on Saturday, July 30, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Smoking Cessation / Cochlear Implants / Laparoscopic Pancreatic Surgery appeared first on Mayo Clinic News Network.

Listen to the program on Saturday, July 30, at 9:05 a.m. CDT.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Smoking Cessation / Cochlear Implants / Laparoscopic Pancreatic Surgery appeared first on Mayo Clinic News Network.

On Saturday, August 17th, Mayo Clinic Radio will feature a compilation program from previous programs based on the abdominal cavity. Joseph Murray, M.D., will discuss celiac disease and gluten sensitivity.  John Pemberton, M.D., talks about the colon and colonoscopy.  Laparoscopic surgeon Michael Kendrick, M.D., discusses how surgery is now performed on the abdomen with only a few small incisions.  Michael Sarr, M.D., will wrap things up with a discussion on gastric bypass.  We hope you will join us.

Note: You can listen to the program LIVE Saturdays at 9 am CT on I Heart Radio via KROC AM. The show is taped for rebroadcast by some affiliates. On Twitter follow #mayoradio and tweet your questions.

Listen to this week’s Medical News Headlines at News Segment Aug 17, 2013 (right click MP3).

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post MAYO CLINIC RADIO appeared first on Mayo Clinic News Network.