World’s First Successful ViKY Robot-assisted Surgery For Pancreatic Tumors

This month Fox Chase Cancer Center performed the world's first successful minimally invasive distal pancreatectomy using the ViKY® system's revolutionary robotic, compact laparoscope holder. The technology, developed in France and tested on thousands of patients in Europe, made its debut in a cancer setting in the United States at Fox Chase. "Fox Chase is among only a handful of institutions worldwide using robotics or laparoscopy to treat patients with nearly all types of cancer," says Robert G. Uzzo, MD, FACS, chairman of the department of surgery at Fox Chase. "The use of technology, like the ViKY system, reinforces our Center's commitment to excellence in minimally invasive surgical techniques for the care of patients with both benign and cancerous conditions."

Fox Chase surgeon Andrew A. Gumbs, MD, who specializes in minimally invasive hepato-pancreatic and biliary (HPB) surgery, explains, "This system is so versatile that surgeons like me are able to use it for many different laparoscopic procedures, including those in the gastrointestinal, urologic, thoracic and gynecologic regions."

Typically with minimally invasive procedures, like a laparoscopic distal pancreatectomy, surgeons use both hands to manipulate the surgical tools and need an assistant to manipulate the endoscope—a thin, lighted tube equipped with a camera that allows the surgeon to view the surgical field.

Gumbs performed this first ever ViKY assisted minimally invasive distal pancreatectomy on a 65-year-old man who was diagnosed with two pancreatic cysts, one of which is potentially cancerous. Pathologists are currently evaluating the cyst.

"The new ViKY robotic laparoscope holder acts as an extra hand during surgery, giving me stability and steadiness," adds Gumbs. "The view of the surgical field is critical, so ViKY's pinpoint accuracy helps me perform more complex procedures laparoscopically." Unlike typical laparoscope holders, the ViKY system's holder is lightweight, easy to set up and use, and takes no floor space.

Standard treatment for pancreatic cancer is surgery to remove the head or tail of the pancreas. When patients present with pancreatic cancer localized to the tail of the pancreas (instead of the head), they undergo a distal pancreatectomy, in which the surgeon removes the tail of the pancreas and leaves the head attached. The remaining portion can function normally by producing and releasing digestive enzymes and hormones. Patients with pancreatic cancer are typically treated with surgery followed by radiation therapy and/or chemotherapy to reduce the risk of recurrence.

The ViKY system gave Gumbs precise control of the laparoscope while he performed the distal pancreatectomy. The endoscope moves according to the surgeon's orders, either through voice recognition or footswitch control.

Before the ViKY technology was available patients might have undergone open surgery. Depending on the complexity of the case, the surgeon may have considered open abdominal surgery, requiring a large incision and a lengthy recovery. Minimally invasive surgical techniques, like the surgery Dr. Gumbs performed, benefit patients in many ways, including a shorter hospital stay, faster recovery, quicker return to daily activity, less risk of infection and less scarring and bleeding.

Gumbs was the first American surgeon to complete a minimally invasive HPB fellowship at the Institut Mutualiste Montsouris in Paris, France. This is the hospital where the first published case of a single incision laparoscopic cholecystectomy in the world was done using the ViKY system. Gumbs is responsible for bringing the ViKY system to Fox Chase and will be training fellow surgeons on this technology.

The ViKY system is manufactured by Endocontrol Medical in La Tronche, France. Endocontrol is an innovative company offering robotic solutions for endoscopic surgeries. Endocontrol was created by Clement Vidal and Patrick Henri of Joseph Fourier University, Grenoble, France, a worldwide leader in computer assisted and robotic surgery.

Acetaldehyde In Alcohol: 'Hangover Chemical' May Be Overlooked Risk Factor For Cancer

New evidence by researchers at the Centre for Addiction and Mental Health (CAMH) and researchers in Germany shows that drinking alcohol is the greatest risk factor for acetaldehyde-related cancer. Heavy drinkers may be at increased risk due to exposure from multiple sources.Acetaldehyde is ubiquitous in daily life in Ontario. Widely present in the environment, it is inhaled from the air and tobacco smoke, ingested from alcohol and foods, and produced in the human body during the metabolism of alcoholic beverages. Research indicates that this organic chemical plays a significant role in the development of certain types of cancers (especially of the upper digestive tract), and it is currently classified as possibly carcinogenic by the International Agency for Research on Cancer of the World Health Organization.

New research from CAMH in Toronto and the Chemical and Veterinary Investigation Laboratory Karlsruhe (CVUA) in Germany recently provided the necessary methodology for calculating the risk for the ingestion of alcoholic beverages.

The team found that risk from ingesting acetaldehyde via alcoholic beverages alone may exceed usual safety limits for heavy drinkers. Their risk assessment study found that the average exposure to acetaldehyde from alcoholic beverages resulted in a life-time cancer risk of 7.6/10,000, with higher risk scenarios (e.g. contaminations in unrecorded alcohol) in the range of 1 in 1,000. As such, the life-time cancer risks for acetaldehyde from ingestion of alcoholic beverages greatly exceed the usual limits for cancer risks from the environment.

The research team noted, however, that this risk is compounded by the addition of acetaldehyde exposure from different sources. "The problem with acetaldehyde has been that although it has been recognized as toxic by Health Canada some years ago, most risk assessments to date were based on one source of exposure only" explained Dr. Jürgen Rehm, the lead scientist of the Toronto group and head of the Public Health and Regulatory Policies section at CAMH. "This has led to a negligence of the overall risk."

For example, in Toronto, even though there are limits for air exposure of acetaldehyde set by the responsible Public Health agency, these limits have been surpassed in the past. Alone, the risks associated with surpassing limits of acetaldehyde from the air may not yet be alarming, but for heavy drinkers and smokers, it adds to the acetaldehyde levels already received from these sources. This overall risk then surpasses established safety limits.

"Their risk assessment of acetaldehyde present as a congener in alcoholic beverages touches the tip of the iceberg," according to a Commentary on the CAMH/CVUA study in the journal Addiction.

New Lab Evidence Suggests Preventive Effect Of Herbal Supplement In Prostate Cancer

DHEA is a natural circulating hormone and the body's production of it decreases with age. Men take DHEA as an over-the-counter supplement because it has been suggested that DHEA can reverse aging or have anabolic effects since it can be metabolized in the body to androgens. Increased consumption of dietary isoflavones is associated with a decreased risk of prostate cancer.Red clover (Trifolium pretense) is one source of isoflavones. Both supplements may have hormonal effects in the prostate and little is known about the safety of these supplements.

In a recent report in Cancer Prevention Research, a journal of the American Association for Cancer Research, researchers report that DHEA levels can be manipulated in cells in the laboratory to understand its effects.

Julia Arnold, Ph.D., a staff scientist at the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, said more research is necessary in an environment where men and women concerned about health problems tend to self-prescribe based on information they find on the Internet.

Towards this end, the NCCAM laboratory is studying signaling between human prostate cancer cells and their supporting stromal cells as they grow together in laboratory culture. "DHEA effects in the prostate tissues may depend on how these two cells types 'talk to each other' and further, it may be potentially harmful in tissues containing inflammation or with early cancer lesions because the cells can induce DHEA to become more androgenic," said Arnold.

Combining DHEA with transforming growth factor beta-1 increased testosterone production in the stromal cells and prostate specific antigen protein secretion two to four-fold and gene expression up to 50-fold in the cancer cells. When these cell cultures were treated with red clover isoflavones, the androgenic effects of DHEA were reversed.

"Something is happening in the prostate tissue microenvironment that is illustrating a potential cancer prevention effect from this supplement," said Arnold.

Red clover isoflavones may modify androgenic effects in the prostate but much more work in the laboratory and clinic is needed to validate these effects.

This sort of laboratory manipulation will allow scientists to understand the basic prostate biology as well as learn cellular and molecular mechanisms of over-the-counter supplements and other botanical or herbal agents. Arnold said NCCAM will continue to study DHEA with other supplements to determine any cancer preventive effects.