Laparoscopic central pancreatectomy: Single institution experience of 6 patients

Cunha, Antonio Sa; Rault, A.; Beau, Cédric; Collet, Denis; Masson, Bernard

doi:10.1016/j.surg.2007.01.035

Cited by 83 publications

(62 citation statements)

References 24 publications

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“…2,3,[15][16][17][18] These facts and the possible different selection criteria of the patients make it difficult to compare our results with those in Recently a 6-case series for LMP has been published in which a PG is performed in all patients. 7 PG is technically easier and faster, as just one anastomosis is needed, but at least in this experience, it also delays the oral feeding that was resumed in a median of 11 days.…”

Section: Discussionmentioning

confidence: 73%

“…One single 6-case series about LMP has been published with pancreatogastrostomy (PG) reconstruction in all cases. 7 We have found only 2 references in the literature about LMP with roux-en-Y duct-to-mucosa pancreaticojejunostomy (PJ), being one of them is our first case included in the Spanish National Registry of Laparoscopic Pancreatic Surgery. 8,9 The aim of this article was to describe our surgical technique for LMP with duct-to-mucosa PJ and report the results of our initial experience with 9 patients.…”

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confidence: 99%

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Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy

Rotellar¹,

Pardo²,

Montiel³

et al. 2008

Annals of Surgery

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Objective: To present the results of a series of laparoscopic middle pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. Summary of Background Data:Middle pancreatectomy makes it possible to preserve pancreatic parenchyma in the resection of lesions that traditionally have been treated by distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic approach could minimize the invasiveness of the procedure and enhance the benefits of middle pancreatectomy. Methods:From March 2005 to October 2007, 9 consecutive patients with benign or low malignant potential lesions in the pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of them. In the first 2 patients, the pancreas was transected by endostapler; in the last 7, the staple line was reinforced with absorbable polymer membrane. Results:The intervention was concluded laparoscopically in every case except 1 (laparoscopicassisted) in which pancreaticojejunostomy was performed by means of minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of the cephalic stump in the first 2 patients (22%)).The pancreaticojejunostomy fistula rate was 0%. The median postoperative hospital stay was 5 days (range, 3-41). In the last 7 patients, in which pancreas was transected with staple line reinforcement material there were no stump fistulas; morbidity decreased to 14% and the median hospital stay was 4 days (range, 3-30). Conclusions:Laparoscopic middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy can be performed safely using this approach. The method of pancreatic transection seems to be decisive in the incidence of cephalic stump fistulas.From the

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy

Rotellar¹,

Pardo²,

Montiel³

et al. 2008

Annals of Surgery

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“…However, the past results are satisfactory and comparable with classical surgery. A shorter hospitalization period is observed in case of middle pancreatectomy, and comparable occurrence of complications (33-44%), including pancreatic fistulas (22-33%) (2,30,31).…”

Section: Resultsmentioning

confidence: 87%

Middle Pancreatectomy - Own Experience

Jabłońska¹,

Żaworonkow²,

Dranka-Bojarowska³

et al. 2011

Polish Journal of Surgery

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the aim of the study was to analyse early results after middle pancreatectomy based on our experience. Material and methods. During the period between 2008 and 2009, 154 pancreatic resections were performed at the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The following procedures were performed: 109 (70.78%) pancreatoduodenectomies, 32 (20.78%) distal pancreatectomies, 9 (5.84%) middle pancreatectomies, 3 (1.94%) total pancreatic resections, and 1 (0.65%) subtotal pancreatic resection. Early results in case of nine middle pancreatectomies were subject to analysis. Results. Average hospitalization period amounted to 24.28 days (ranging between 8 and 57 days). Mean hospitalization period after surgery amounted to 20.71 days (ranging between 6 and 54 days). Average duration of the surgical procedure amounted to 3.6 hours (ranging between 2.25 and 4 hours). Wirsung's duct required drainage in 4 (44.4%) patients. Pancreatoenterostomy was performed in 5 (55.5%) patients. Early postoperative complications were observed in three (33.3%) patients. The most common complications included wound suppuration and intra-abdominal abscess development observed in two (22.2%) patients. Pancreatic fistula development during the postoperative period was observed in case of one (11.1%) patient. Other early postoperative complications included peritoneal cavity hemorrhage (1-11.1%) and pancreatic necrosis (1-11.1%). Two (2.22%) reoperations were required. Early postoperative mortality amounted to 0%. conclusions. Middle pancreatectomy operations performed in experienced centers are considered as safe procedures with a low rate of complications. The most common indication for middle pancreatectomy is the diagnosis of a benign pancreatic tumor. Key words: middle pancreatectomy, middle segment pancreatetomy, central pancreatectomy, median pancreatectomy * This work was supported by the European Community from the European Social Fund within the RFSD 2 project.The most common standard pancreatic resections, such as pancreatoduodenectomy and distal pancreatectomy are burdened with the risk of postoperative exocrine and endocrine pancreatic insufficiency, as well as complications connected with splenectomy (in case of distal resection). The presence of the abovementioned complications is connected with the depletion of the healthy pancreatic parenchyma during these procedures. Therefore, minimally invasive procedures play an increasing role in surgery, sparing the normal pancreatic parenchyma. In case of benign or border-line malignancy tumors middle pancreatectomies are performed more and more often (1-17).

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“…Similarly, a MIS approach for CP has become increasingly common with the goal of decreasing the impact of morbidity related to the decreased size of incisions, shorter hospital stays, and shorter time until return to work. While both laparoscopic and robotic CP are being performed, laparoscopy may be somewhat limited given the restricted workspace and the inability to articulate instruments in a manner requisite for these complex procedures (18)(19)(20)(21). These limitations are potentially alleviated by the use of robotic surgery.…”

Section: Review Article On Pancreatic Surgerymentioning

confidence: 99%

“…Rates of POPF (34.1%) are comparable to those reported for PD and DP (8,34), while postoperative diabetes mellitus (DM) (3.2%), and exocrine insufficiency (EI) (6.5%) are a relatively infrequent complication. In comparison to open series, the quantity of patients reported in MIS series of CP is even more limited (20,21,35,36). The largest series on laparoscopic CP was performed by Rotellar and colleagues, which included nine patients (20).…”

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confidence: 99%

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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Recent improvements in imaging techniques and more frequent use of cross-sectional imaging have led to an increase in the identification of benign and low-grade lesions of the pancreas. Patients with resectable cancers are commonly treated by either a Whipple procedure or distal pancreatectomy (DP) based on the location of the tumor. Central pancreatectomy (CP) is a less commonly performed operation that has recently been utilized for resection of these now more frequently diagnosed low-grade and benign lesions located in the mid pancreas. Lesions that may have a relatively more indolent nature include branchtype intraductal papillary mucinous neoplasm (IPMNs), mucinous cystic neoplasms, neuroendocrine tumors, and solid pseudopapillary tumors. The goal of a CP is complete extirpation of the lesion, while preserving pancreatic parenchyma to reduce the risks of developing diabetes and exocrine insufficiency (EI). Although open CP has been shown to be safe and efficacious, the outcomes of a minimally invasive approach are still relatively underreported and therefore unknown. In this paper, we describe our surgical approach to performing a CP with an accompanying video demonstration of the key portions of the operation. multiple anastomoses required for restoring continuity of the hepatic duct, pancreatic duct and intestinal tract (1,10). The concerns surrounding CP include high incidence of post-operative pancreatic fistula (POPF) and potentially inadequate oncologic resection in cases of malignancy (9). However, studies have shown that although the rates of POPF after CP are relatively high (20-50%), oftentimes these patients possess soft glands and small ducts, which are both well-established risk factors for POPF (9). Also, in most cases the POPF is clinically insignificant [International Study Group on Pancreatic Fistula (ISGPF) grade A] (9). Therefore, CP is a reasonable approach for centrally located, benign or low-grade pancreatic lesions that allows preservation of pancreas parenchyma and adjacent organs.With increasing utilization of laparoscopic and robotic pancreatectomy, patients can now undergo either an open or minimally invasive surgery (MIS) procedure. Laparoscopic and robotic PD has gained interest due to comparable morbidity, mortality and oncologic outcomes versus open PD when performed in select patients (11-15). For DP, MIS approach has now become the standard of care due to its favorable outcomes in comparison to open DP (11,16). In a recent meta-analysis comparing 1,814 patients undergoing open versus laparoscopic DP, the laparoscopic approach resulted in less blood loss, shorter hospital length of stay (LOS), fewer surgical site infections and lower morbidity (17). Similarly, a MIS approach for CP has become increasingly common with the goal of decreasing the impact of morbidity related to the decreased size of incisions, shorter hospital stays, and shorter time until return to work. While both laparoscopic and robotic CP are being performed, laparoscopy may be somewhat limited giv...

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Laparoscopic central pancreatectomy: Single institution experience of 6 patients

Cited by 83 publications

References 24 publications

Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy

Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy

Middle Pancreatectomy - Own Experience

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

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