Edgar Johnson, a former pastor and state missionary living in Rock Spring, Georgia, called his physician in March after losing weight, feeling weak and experiencing pain below his chest cage.
Days later, following a subsequent X-ray and a CT scan, doctors learned Johnson’s pancreas had been enlarged and inflamed for some time: He had cancer.
In April, he met surgical oncologist Dr. Justin Wilkes, who introduced Johnson to the robotic Whipple procedure. The Mayo Clinic defines the Whipple procedure as “an operation to treat tumors and other conditions in the pancreas, small intestine and bile ducts. It involves removing the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct.”
The procedure can be done as an open procedure, a laparoscopic procedure or robotically, according to the Mayo Clinic. Johnson in May became the second patient at CHI Memorial Hospital to have the robotic operation.
To date, four robotic Whipple procedures have been performed at CHI Memorial.
(READ MORE: Hamilton County launching mobile health care units)
Despite its novelty, Johnson said he was not apprehensive about the procedure’s robotic-assisted element, as Wilkes explained the operation explicitly.
Joyce Johnson, Edgar Johnson’s wife, said Wilkes was observant and made sure, along with their daughter, Joy, the couple understood what they were going to face with the Whipple procedure, including its pros and cons.
“He was very thorough with his information to us, which put us at ease knowing that we were making the right decision,” Joyce Johnson said.
Wilkes added that the recovery process would be better and easier in a robotic operation, Edgar Johnson said. And it was. Johnson said he spent around four days in the intensive care unit following the procedure but didn’t have much pain afterward.
“It was not as bad as when my appendix ruptured years ago,” he said. What I went through with this Whipple was not as painful as I thought it would be.”
Johnson said surgeons removed 21 lymph nodes and his gallbladder, in addition to rerouting corresponding blood vessels.
“I was nervous, yes,” Johnson said about being put to sleep prior to surgery, However, he added he had “a faith in the Lord that everything was going to be fine.”
When Johnson went to visit Gregory Sutton, his doctor at Nashville-based Tennessee Oncology, he said Sutton was pleased.
“He said, ‘Well, let me see your scar,’ and I pulled up my shirt,” Johnson said. “There were two little holes right below my chest. He said, ‘No, I thought they were going to cut you open.’ I said, ‘No, that’s all they did.’ He was very much surprised.”
Now, Johnson said he can move around his house by walking with a rollator walker or cane, depending on how far he needs to go. There are side effects to the robotic Whipple, and one of them is appetite loss. Johnson said he weighs around 140 pounds compared to his previous 180.
“I feel fine at times, almost like nothing happened, and then there are a few times when I feel weak because I’ve lost so much weight,” he said. “There’s things that you probably used to like to eat you now can’t eat much because with the Whipple surgery, they take part of your stomach, which reduces your intake.”
Johnson said Wilkes informed him of this effect prior to the operation, which includes decreased blood loss, a shorter length of stay and less pain as part of its advantages, despite a longer operating time, compared to its traditional version.
THE BENEFIT
Pancreatic cancer progresses rapidly with no available method of early detection, making it among the most dangerous cancer diagnoses to have, according to UnityPoint Health. The cancer has shown resistance to chemotherapy.
Even after the pancreatic cancer has been removed, Wilkes said 80% of people will still have a recurrence.
“Pancreatic cancer is still a really bad cancer,” Wilkes said. “The operation’s great, and it’s beautiful and it’s elegant, and it still doesn’t change the biology of the disease, which is still disheartening sometimes.”
The ideal patient is someone who can withstand long anesthesia, is relatively healthy, has a small tumor and a body mass index of under 30, Wilkes said. If a patient is unable to have their stomach filled with tense air for several hours while under a large amount of anesthesia, he will not suggest a robotic-assisted operation.
Longevity is another one of the Whipple procedure’s benefits for patients.
“In patients that have resectable cancer, they still live longer if you get that tumor out,” he said. “Even the patients that have recurrence, if you compare them to patients that never got a resection, they live longer. So, you have provided them longer life, but ultimately, there’s an 80% chance this could come back, and they could be dealing with it again.”
THE SURGERY
Wilkes said in an interview the advantages of the robotic-assisted Whipple procedure compared to an open surgery are that patients experience less pain and, in many cases, a shorter length of stay following the operation, which involves smaller incisions.
The Chattanooga Times Free Press observed part of a live robotic Whipple procedure. Dr. Rishabh Shah attended to the da Vinci Surgical System robot, helping Wilkes. Wilkes said the two doctors trade off who operates the robot, ensuring fresh eyes and minds are managing it at all times.
“You have articulating instruments, so your hands can move like wrists and fingers in the body, as opposed to laparoscopy, where you basically can just kind of open and close for the most part, which some people got very facile with — not me,” he said. “That’s the big advantage for the surgeon.”
Wilkes said both the reconstruction and dissection elements are difficult for him as a surgeon. In the case of the latter, he said it’s nice to have good visualization of big blood vessels that can bleed and be difficult for surgeons to control.
“I actually find the magnified view of the camera and the articulating instruments to make that part easier a lot of times than when doing it open, where you just feel so far away sometimes,” he said.
The Whipple surgery has been done as an open procedure for a long time, Wilkes said.
According to John Hopkins Medicine, an open procedure means cutting the skin and tissues so that the surgeon has a full view of the structures or organs involved.
“There was a short period where people were doing them laparoscopically, and some still are, but it’s very difficult because you’re using these straight sticks and trying to do things with limited visualization,” Wilkes said of the Whipple surgery. “The advantage that the robot really brought on was 3D visualization.”
When reconstructing the body, surgeons are sewing the intestine to the pancreas, and the intestine to the bile duct. He said he finds the control of the needle to be much better with the robotic instruments, as surgeons can articulate at 360 degrees.
“It has tremor control, which none of us want to admit, everybody has a little tremor,” Wilkes said. “Certainly at the end of maybe a difficult resection where you’re cutting out this tumor, you get tired, and so to have that tremor control and just control … I feel like, personally, my reconstructions have been better.”
Concerning the long term-effect of robotic-assisted procedures on medicine, Wilkes said it’s all a continuum. As technology like the da Vinci Surgical System increasingly improves, more surgeons will be able to use them to complete procedures, allowing patients to recover faster.
“Hopefully, for big cancers, the question of whether or not someone can undergo the surgery starts to become less and less of a question, right?” he said. “Because a lot of times, we’re making a decision on this patient’s cancer.”
Staff photo by Matt Hamilton/ Edgar and Joyce Johnson at their home in Rock Spring, Ga. on Tuesday, October 22, 2024.EDGAR JOHNSON’S STORY
Johnson said he went on chemotherapy for a while for his cancer, per doctors’ instructions, which made him weak and caused his blood pressure to drop. He said doctors paused the treatment to address an upper intestine infection that traveled to his right foot.
Johnson recently had a procedure to aspirate his foot — removing some pus — and he is still recuperating. All those health issues are unrelated to the robotic Whipple procedure, he said, which he labeled as “a piece of cake.”
Before his operation in May, Johnson said he went online to research the Whipple procedure.
“I read what other people said, but what some of them said wasn’t what I experienced,” he said. “I was better.”
Health problems are only one part of his story.
In November, Johnson will turn 83, and he has been married to his wife for 62 years.
“The Lord’s blessed us, and kept us close to him,” he said in good spirits.
Contact Leah Hunter at lhunter@timesfreepress.com or 423-757-6673.
