Chabot

pancreas, WhippleOn March 4, 2014, the first robotic Whipple procedure was performed by Dr. John Chabot, Executive Director of The Pancreas Center, and Dr. Yanghee Woo at NewYork-Presbyterian/Columbia University Medical Center.

This is exemplary of The Pancreas Center’s mission to continually advance the quality of pancreatic care.

What is a Whipple Procedure?

For those who may not know, the Whipple procedure is an operation in which surgeons remove the head of the pancreas, which constitutes almost forty percent of the pancreas, as well as the duodenum, the first section of the small intestine. This piece of the intestine is closely attached to the head of the pancreas, so they must be removed together as a unit. A portion of the stomach, as well as the gallbladder and a portion of the bile duct, may be removed as well.

Typically, the Whipple procedure is performed most commonly to treat pancreatic cancer, but also cancer of the duodenum and pancreatic ducts, and occasionally, chronic pancreatitis. Also known by its technical name, pancreaticoduodenectomy, the Whipple procedure received its more familiar name after its founder, Dr. Allen Whipple, who was Chairman of the Department of Surgery at NewYork-Presbyterian/Columbia for twenty-five years.

The robotic Whipple procedure is significant for a few of its advantages, notably that it improves cosmetic outcomes and reduces post-operative pain when compared to the traditional approach. Another potential advantage, currently under evaluation, includes shortening patients’ recovery time before starting chemotherapy. “If we can enhance patients’ recovery, they can begin their post-operative chemotherapy sooner,” explains Dr. Chabot. Currently, it’s common for patients to wait eight to ten weeks after surgery before starting chemotherapy. “We would much prefer if we started at five to six weeks,” says Dr. Chabot.

The Pancreas Center prepared for the procedure with a lot of work and effort, to ensure the right team was in place with a strong background in both robotics and the Whipple procedure itself. “Dr. Woo is one of the world’s leading experts in upper abdominal robotic surgery, having performed over two hundred robotic operations for gastric cancer. I have extensive experience in pancreatic surgery, especially with the Whipple procedure,” explained Dr. Chabot. Dr. Woo and Dr. Chabot also recruited a dedicated operating room staff with expertise in robotic surgery, spanning numerous departments. “Together, we performed a multitude of simpler pancreatic operations until we developed a sufficient comfort level to complete this more complex surgery.”

At the Pancreas Center, the first robotic Whipple procedure was a big step forward but there’s still work to be done according to Dr. Chabot, “We’re not going to start doing every Whipple procedure robotically. I believe in three to four years, however, we might be doing half of our Whipple procedures robotically.” Dr. Chabot concluded, “We must always assess the patients’ needs and perform the treatment best for the patient.”

For more information about The Pancreas Center, please visit our website at pancreasmd.org or call our new patient coordinator at 212-305-9467.

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Pancreas Center Spotlight on Staff: Lynette Marte-Gonzalez

by Columbia Surgery on March 24, 2013

Mission Possible: Access to Care for All.

Lynette Marte-Gonzalez joined the Pancreas Center as the New Patient Coordinator in 2010.

Lynette Marte-Gonzalez

Lynette Marte-Gonzalez

In her role as the new patient coordinator, Lynette helps to make new patients’ experience at the center as easy, efficient, and smooth as possible. In particular, Lynette is on the front line of the center’s highly proactive approach to ensuring that patients receive appointments very quickly, that they see the right specialists for their health issues, that records are in order, and that any issues with insurance, language barriers, or other problems are addressed. In this interview, Lynette tells us about the Pancreas Center’s unique process and how that helps to provide the best care possible to patients with pancreatic diseases.

Q: What are some of the common difficulties patients face when seeking care?

Lynette: The most significant difficulties involve insurance, limited referrals from primary care providers, language barriers, and overall unfamiliarity and fear of navigating through the hospital system. Some patients are afraid to even call the center because they think it will take many months to get an appointment, which is completely unfounded.

Q: How do you address each of these issues? Let’s start with insurance, since that is at the top of the list.

Lynette: We see several common problems with insurance. First, readers should understand that the center includes specialists in Surgery, Interventional Gastroenterology, and Oncology (cancer treatment). In some cases, a person’s insurance may be accepted by a physician in one specialty, but not another. Medicaid is accepted by most practitioners, but not all. To address this complicated situation, we have implemented the policy of having people come for treatment regardless of their insurance policy – and we’ll find a way to make it work. Always.

Q: How are you able to provide care if insurance is not accepted or if the patient does not have insurance?

Lynette: We are creative and resourceful, and we have enough specialists available at NYP/Columbia that we can assemble the right teams to work within these constraints.

Perhaps most importantly, we have an excellent system in place in the form of our weekly multidisciplinary conference. Every Thursday, our entire team meets to discuss every new patient’s case. These meetings are directed by the Pancreas Center Director, John Chabot, MD. Many people come to the center specifically because they want to receive care from him. Even if their insurance will not work to have him as their primary surgeon, they still receive care from him in several ways. First, at our multidisciplinary conference each case is reviewed by the surgeons and physicians to determine their plan of care. Second, if surgery is required and insurance will not allow him to be the primary surgeon, he may still participate in surgery as the assistant, along with one of our other highly experienced and qualified surgeons.

In some cases, the out-of-pocket costs present a problem for patients. In these cases, the Pancreas Center will find a way to make it work. Bottom line, if a patient needs care, we find a way to provide it. If the hospital accepts the insurance at all, we can make sure the patient receives care.

Q: Tell us about the issue concerning referrals from primary care physicians.

Lynette: At the time of service some patients may require a written referral from their insurance plans. The patient may be unaware that the referral is needed, or the outside doctor may have simply not provided it, or sometimes the issue gets lost in the mix if the patient’s first language is not English. Regardless of the cause, we do the legwork by determining what is needed and obtaining the proper referral by contacting the appropriate offices.

Q: Are language barriers a common issue?

Lynette: Here in northern Manhattan, we see many patients who may not speak English or speak it well. We do several things to work with this issue. First, we have Spanish speaking staff including myself, and we will provide translators for patients who speak virtually any other language. Second, before patients come in for their appointments, we send paperwork home and give them a week or so to fill it out. We will send it by email or regular mail, whichever the patient prefers. Then, if they need the assistance of a translator to complete the forms, there is time to do this before the appointment. That way, during the appointment we can all focus on the exam, reviewing records, and determining the patient’s plan of care, without getting delayed by incomplete paperwork.

Q: Does it take a long time to get an appointment at the Pancreas Center?

Lynette: No, we make sure we schedule patients very quickly. The goal throughout NewYork-Presbyterian/Columbia is to schedule patients within 14 days. At the Pancreas Center, we schedule patients to come in within 7 days, and we are striving for even better.

In many cases, the patient does not know which specialist he or she should see. My first step, therefore, is to obtain all the patient’s records and have them reviewed by our physicians. That review ensures that we make the appointment with the correct specialist who can address the person’s condition correctly.

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2013 GI Innovations: Second Annual Peter D. Stevens Course on Innovations in Digestive Care

February 21, 2013

Tweet Course: NewYork-Presbyterian’s Second Annual Peter D. Stevens Course on Innovations in Digestive Care Date: Thursday, April 25 – Friday, April 26, 2013 Location: Weill Cornell Medical College 1300 York Avenue at East 69th Street New York, NY 10065 Program Co-Directors: John A. Chabot, MD, FACS Michel Kahaleh, MD, AGAF, FACG, FASGE Charles J. Lightdale, […]

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Stories of Hope: David Mankuta

November 29, 2012

TweetAfter several weeks of abdominal pain last summer, I visited my primary physician. He ran a few tests, suspecting that my pain may have been related to previous issues, and I went home. By the time I went back two weeks later, I had developed some back pain. He promptly focused on the pancreas since […]

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Pancreatic Cancer – Personal Perspectives

October 4, 2012

TweetWhen you or someone you love has been diagnosed with pancreatic cancer, life can seem to be instantly turned upside-down. What now? A never-ending list of questions seems to grow: Why did this happen? Is recovery possible? What comes next? Know you are not alone. According to the American Cancer Society, approximately 43,920 new cases […]

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U.S. News & World Report Recognizes 33 Top Doctors at NYP/Columbia Department of Surgery

September 21, 2012

TweetCongratulations to the thirty three surgeons at the Department of Surgeon for being recognized by U.S. News & World Report in their 2012 list of Top Doctors. Of these top-ranked surgeons, U.S. News further identified seventeen physicians as being in the top one percent in the nation in their specialties. U.S. News & World Report’s […]

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NY Magazine Recognizes 16 Top Docs at NYP/Columbia

June 7, 2012

TweetCongratulations to sixteen surgeons at the Department of Surgery for being named top doctors by New York Magazine. This annual list recognizes 1160 physicians from New York, New Jersey, and Connecticut who are considered top in their fields of expertise. This year, the magazine recognized faculty from nine divisions at NYP/Columbia Department of Surgery: Plastic […]

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The Ride of My Life: A Fight to Survive Pancreatic Cancer

March 19, 2012

TweetA book by Bob Brown, a pancreatic cancer survivor. What would you do if your doctor diagnosed you with inoperable pancreatic cancer? If you or someone you love has been diagnosed, this amazing story of survival will move you, amuse you, and instill hope in your heart. Written by a patient at NewYork-Presbyterian/Columbia and published […]

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2011 Pancreatic Cancer Awareness Day

December 20, 2011

TweetThis year’s Pancreatic Cancer Awareness Day was the largest and most successful yet, says event organizer Christine Rein. One hundred fifty participants attended the event, which was held Saturday, November 12, 2011 at NewYork-Presbyterian/Columbia. The program provided information about the pancreas and its function, genetics, risk stratification and screening, cancer-therapy breakthroughs, surgical options, cysts, pre-cancerous […]

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Profile in Compassion: Sue Mirza Carries Husband’s Legacy, Potentially Transforming the Treatment of Pancreatic Cancer

November 8, 2011

TweetOn first glance, the story may appear cliché; a spouse dies, and the surviving spouse gives to a charitable cause, hoping to confer some measure of permanence to his or her loved one’s memory. Repeated in infinite variations, the uplifting closure softens just a little bit of the survivors’ sadness and pain, and makes a […]

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