AIIMS Delhi Performs Total Laparoscopic Whipple on 11-Year-Old Girl with Rare Pancreatic Tumour

New Delhi: The Department of Paediatric Surgery at AIIMS Delhi has achieved a milestone by successfully performing the first Total Laparoscopic Whipple operation on an 11-year-old girl, making her the youngest patient worldwide to undergo this complex procedure entirely by laparoscopic route by any paediatric surgeon.

The lead surgeon for this operation was Dr Anjan Kumar Dhua, a Professor of Paediatric Surgery in Delhi, India.

The young patient, hailing from Garhwa, Jharkhand, had been experiencing persistent abdominal pain. Investigations revealed a rare pancreatic tumour known as a Solid Pseudopapillary Epithelial Neoplasm (SPEN), necessitating the intricate Whipple’s procedure, which involves the surgical removal and reconstruction of a significant part of the pancreas and the digestive system.

The pancreas is a small yet crucial organ located deep within the abdomen. It closely surrounds several major blood vessels supplying vital organs throughout the body.

Because of its intricate placement and proximity to these important vessels, surgical procedures involving the pancreas require extraordinary care, precision, and meticulous attention, leaving absolutely no margin for error.

Typically, this surgery is done through a very long cut on the tummy, which can be painful afterward and leave a big scar. Considering several important factors, the operating team decided to perform the same surgery using only four tiny incisions—two measuring just 5 mm and another two measuring 10 mm.

Driven by the passion to offer the best to this young patient, the surgical team tirelessly operated for eight and a half hours with only 80 ml of blood loss, demonstrating their commitment to precision and patient comfort throughout this extended procedure.

The patient had a smooth and comfortable recovery with minimal postoperative pain, a short hospital stay, and cosmetically pleasing outcomes due to tiny laparoscopic incisions. Most importantly, the procedure strictly adhered to essential oncological principles, ensuring complete tumour removal and patient safety.

Prof Anjan Dhua said, “Technically pancreaticoduodenectomy, also known as the Whipple operation, is considered the pinnacle of gastrointestinal surgery so far as the technicalities of the operation are concerned, and performing it laparoscopically further elevates the complexity. Given its rarity in paediatric surgical practice, such cases have traditionally been managed through open surgery. However, our extensive cumulative experience in advanced laparoscopic surgery allowed us to push our limits and successfully offer the advantages of minimally invasive keyhole surgery to a paediatric patient, a benefit that adult laparoscopic surgeons had predominantly provided to their patients.”

He added that “SPEN is a rare but highly curable cancer of the pancreas, predominantly affecting young women in their second or third decades of life. Complete surgical removal of the tumour remains the only definitive treatment. Considering this, our young patient can be considered 'cured' as she eagerly awaits returning to school and normal activities. We plan to continue regular surveillance to ensure her sustained well-being.”

From the anaesthesia perspective, as Dr Bikash Ranjan Ray (Professor of Anesthesia, AIIMS Delhi) highlighted, the team was fully prepared for a prolonged operation and anticipated intraoperative blood loss; fortunately, the surgery proceeded without any significant anaesthetic complications or blood loss. Excellent pain management ensured that the child experienced a smooth, pain-free recovery in the postoperative period.

Prof Sandeep Agarwala (HOD Pediatric Surgery, AIIMS Delhi) said that "this accomplishment highlights the extraordinary capabilities of the Paediatric Surgery Department, which draws upon extensive experience in managing complex liver, biliary, and pancreatic conditions. This successful procedure not only marks a promising future for minimally invasive paediatric surgery but also serves as an inspiration, showcasing the institution's commitment to providing world-class, compassionate care."