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A cancer in the body or tail of the pancreas is removed with the spleen and the lymph nodes along its vessels. Working from right to left lets the surgeon confirm a clear margin before anything that cannot be undone, and the robot makes that work more precise. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 5 October 2026
Shah’s Gastro, Cancer & Robotic Surgery Centre. Super-specialty training in surgical gastroenterology, two higher degrees in it, and 18 years of experience in GI and cancer surgery, including pancreatic surgery by open, keyhole and robotic approaches. Every pancreatic cancer is discussed at the tumour board before the operation and the approach are chosen.
For a cancer in the body or tail of the pancreas the operation is a distal pancreatectomy: the left part of the pancreas is removed together with the spleen and the lymph nodes along the splenic artery and vein, in one block. No join to the bowel is needed.
The dissection runs from right to left. The pancreas is divided first at its neck, to the right of the tumour, and the margin is confirmed before the splenic vessels are divided — so that, if the cancer proves unremovable, nothing irreversible has been done.
The robot adds wristed instruments and a steady three-dimensional view at the two hardest places — along the portal vein at the neck and at the origin of the splenic artery — and in pooled studies it is converted to open less often than keyhole surgery. The cancer operation itself is the same.
The aim is the tumour with a clear margin of at least a millimetre all round, the left pancreas, the spleen and the lymph nodes along the splenic vessels — all in one block — and a closed pancreatic stump that does not leak.
The spleen is removed with a cancer because the lymph nodes at its hilum and along its artery are part of the area the cancer drains to, and because the splenic vein is often in contact with the tumour. Keeping the spleen is an option for some benign or low-grade pancreatic tumours, not for a pancreatic cancer.
The lymph node removal is the standard field along the splenic artery, the common hepatic artery and the coeliac axis. Taking a wider, extended field adds complications without adding survival, so it is not done.
Whether this operation is the right first step — or whether chemotherapy should come first — is settled at the tumour board on the scans before surgery is booked. That workup is described on the robotic pancreatic cancer surgery page; this page is about the operation itself.
The robot gives the surgeon instruments that bend at the tip, a steady three-dimensional camera under his own control and an extra arm to lift the stomach and the pancreas. In a distal pancreatectomy that matters in two narrow places.
The first is the neck of the pancreas, where it lies on the portal vein: the tunnel behind the neck is made with the vein in direct view, and the gland is divided with a clean edge. The second is the origin of the splenic artery from the coeliac axis, behind the stomach, where the artery is cleaned and its lymph nodes lifted away before it is divided. Wristed instruments let both be done in small movements rather than at an angle.
In pooled studies comparing robotic with keyhole distal pancreatectomy, the robotic operation needed conversion to open surgery less often, with similar rates of leak from the pancreas. What the robot does not change is the oncology: the same pancreas, spleen and nodes are removed, and the margin rule is the same.
The patient lies on the back, tilted to the right so that the colon and small bowel fall away from the left upper abdomen. The robot is docked from the head end, with its ports across the upper abdomen and an assistant port for the stapler and suction.
Before any dissection, the camera looks over the liver and the lining of the abdomen. Small deposits too small for any scan are occasionally found in body and tail cancers. If they are, a biopsy is taken and the operation stops there, because removing the pancreas would not help — the plan then moves to chemotherapy without the delay of recovering from a major operation.
If there is no spread, the stomach is lifted off the pancreas by opening the space behind it, and the bend of the colon near the spleen is moved down to expose the whole length of the body and tail.
The traditional operation started at the spleen and worked towards the middle. The approach used here starts at the neck of the pancreas, to the right of the tumour, and works towards the spleen, so the margin at the cut pancreas is known early.
The neck is separated from the portal vein beneath it, and the gland is divided with a stapler or a fine energy device. Where the cut edge is close to the tumour, a slice is sent for frozen section while the operation continues; if it shows cancer, more pancreas is taken.
The dissection behind the pancreas then follows one of two planes. When the tumour is confined to the gland, the plane runs in front of the fatty capsule of the left kidney. When it reaches into the tissue behind the pancreas, the plane is taken deeper, behind that capsule, and the left adrenal gland can be removed with the specimen to keep the margin clear.
The splenic artery is found at its origin, cleaned with its lymph nodes and divided between clips. The splenic vein is divided where it joins the portal system. The specimen — pancreas, spleen and nodes — is then freed towards the left, the short vessels to the stomach and the attachments of the spleen are divided, and the whole block is removed in a bag through a short cut low on the abdomen.
The cut end of the pancreas is the weak point of this operation, because pancreatic juice can leak from it. It is closed with a stapler and, where the gland is soft or the line looks doubtful, oversewn — a step the robot’s wristed needle holder makes straightforward. The main duct is closed separately when it can be seen.
A drain is left next to the stump. The amount of pancreatic enzyme in its fluid on the first day after surgery tells the team whether a leak is developing and when the drain can come out.
All three approaches remove the same pancreas, spleen and nodes, and the same margin rule applies. The differences lie in how each works at the neck and the splenic artery, how often it must be converted, recovery, and cost.
| Open | Keyhole (laparoscopic) | Robotic | |
|---|---|---|---|
| Incision | Long upper-abdominal cut | Small ports and a short cut low down for the specimen | Small ports and a short cut low down for the specimen |
| Looking for hidden spread first | After opening the abdomen | Before any dissection, through the camera | Before any dissection, through the camera |
| Working along the portal vein at the neck | Direct, by hand | Straight instruments in a tight space | Wristed instruments and a steady 3D view |
| Splenic artery at its origin, and its nodes | Direct | Demanding behind the stomach | Fine, angled work at the origin |
| Closing the cut pancreas | Stapled or sewn | Usually stapled | Stapled, and oversewn with wristed instruments when needed |
| Conversion to open | Not applicable | More frequent in pooled studies | Less frequent in pooled studies |
| Blood loss | Highest | Lower | Lower |
| Lymph nodes removed | The same field along the splenic vessels | The same | The same |
| Hospital stay and return to work | Longest; the wound limits lifting | Shorter | Similar to keyhole |
| Time in theatre | Shortest | Longer | Longest |
| Cost | Lowest | Moderate | Highest |
| Suited to | A tumour touching major vessels after chemotherapy, removal of the coeliac axis, or a previously operated abdomen | A tumour well away from the major vessels | A body or tail cancer needing a clean margin at the neck and careful work at the splenic artery origin, without major vessel involvement |
Trials have shown that keyhole distal pancreatectomy gives a quicker recovery than open surgery with similar complication rates, and the same cancer results in experienced centres. Robotic surgery matches keyhole for the cancer operation and is converted to open less often; it is offered here for the patients in whom that precision at the neck and the artery matters.
Open surgery is safer when, after chemotherapy, the tumour still touches the major arteries or the portal vein, when the coeliac axis has to be removed with the tumour, or when earlier operations have left dense adhesions. Vascular control in those situations is more reliable with the abdomen open.
For a small tumour well away from the vessels, keyhole surgery in experienced hands does the same operation at lower cost, and Dr Harsh Shah will say so if that is your situation.
If, during a robotic or keyhole operation, bleeding is better controlled by hand or the tumour proves more attached than the scans showed, the operation is completed open. That step is consented for beforehand.
Recovery follows an enhanced-recovery pathway: up and drinking the day after surgery, eating soon after, the catheter out early, and the drain removed when its fluid shows no leak. The leak of pancreatic juice from the stump is the commonest problem after this operation; it is usually managed by keeping the drain in longer.
Any small bleed from the drain, the wound or in vomit, even one that stops on its own, is treated as an emergency warning and investigated at once with a CT angiogram — never observed overnight.
Removing part of the pancreas can bring on diabetes or make existing diabetes harder to control, and some patients need enzyme capsules with meals. Sugars and digestion are checked at each visit.
Without a spleen the body fights certain infections less well. Vaccines are given before surgery — ideally at least two weeks before — antibiotics are prescribed afterwards, and any fever is a reason to see a doctor the same day. The histology is discussed at about two weeks, and chemotherapy usually follows once you have recovered.
Watch Dr Harsh Shah explain how tumours of the head, body and tail of the pancreas differ (YouTube).
A robotic distal pancreatectomy costs more than a keyhole or open one, because of the robotic instruments used in each case and the longer theatre time. The vaccines before surgery, a frozen section, and a longer stay if a leak develops add to the total. The office prepares a written estimate before admission.
Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the pre-authorisation paperwork is prepared by the office. Ask whether your policy covers robotic surgery and up to what limit. Bring the policy documents, photo identity, the CT on disc with its report, the EUS and biopsy reports, and a list of current medicines, including any for diabetes and any blood thinners.
★★★★★
“We are very thankful to Dr. Harsh Shah for successfully performing the Whipple’s procedure. From the beginning, he explained everything clearly and gave us great confidence throughout the treatment. Today, we are happy to share that we received the discharge and are going home with a positive feeling. Thank you, Dr. Harsh Shah, for your expertise, care, and support. Highly recommended for GI surgery. — Desai Sonal, Google review, Apollo Hospital, Bhat listing”
★★★★★
“My patient was having tumour in abdomen. Dr Harsh Shah did an operation called whipple’s operation. Today after 7 days of operation, we are being discharged from the hospital. We are happy with the services provided by Dr Harsh Shah & Apollo Hospital. — piyush aanjna, Google review, Gota clinic listing”
★★★★★
“Met with Dr. Harsh Shah for the consultation of one of my relative. Dr. Harsh Shah is an exceptional surgical oncologist in Ahmedabad. His expertise in treating complex GI cancers like liver, pancreas, and colon cancers is truly remarkable. He explains everything clearly and gives patients full confidence in their treatment. Highly recommended for anyone looking for a skilled and compassionate cancer specialist. — Nagesh Patidar, Google review, Gota clinic listing”
Real Google reviews from Dr Harsh Shah’s listings, reproduced exactly as written.
Its lymph nodes and vessels lie in the path the cancer spreads along, and the splenic vein often touches the tumour. Removing the spleen with the pancreas clears that area in one block.
The pancreas is cut first at its neck and the margin checked before the splenic vessels are divided. If the cancer turns out not to be removable, nothing irreversible has been done.
It removes the same tissue. Its gain is precision at the neck and at the splenic artery, and in pooled studies it needed conversion to open surgery less often. For a small tumour far from the vessels, keyhole is reasonable.
Pancreatic juice can seep from the cut end of the gland. The drain left beside it shows this early, and most leaks settle with the drain kept in longer, nutrition and sometimes a procedure to drain a collection.
Some patients do, especially if their sugars were already raised. Sugars are monitored during the stay and at follow-up, and treatment is started if needed.
Take the vaccines before surgery, keep the prescribed antibiotics, carry a note that you have no spleen, and see a doctor the same day for any fever.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultation, review of CT, MRI and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 52 reviews
Apollo Hospital — Bhat, Gandhinagar
Admission, robotic, keyhole and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for pancreatic cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
More on robotic surgery for pancreatic cancer at this centre: Robotic pancreatic cancer surgery in Ahmedabad · Robotic surgery for HPB cancers · Robotic cancer surgery at this centre · Pancreatic cancer explained
Send the pancreas-protocol CT, the EUS and biopsy reports and the CA 19-9 ahead of your appointment so the consultation starts with them already read. The operation and the approach are decided at the consultation after examination and at the tumour board. Call +91-63590-11009 WhatsApp the office
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