Minimally invasive pancreatic surgery: the new frontier?

Abstract

Recent advances in minimally invasive pancreatic surgery encompass laparoscopic, retroperitoneoscopic, endoscopic, thoracoscopic, and percutaneous approaches. Applications of endoscopic pancreatic surgery include laparoscopic resection, necrosectomy, drainage of pseudocysts, gastric and biliary bypass, and thoracoscopic splanchnotomy. This review provides an update on laparoscopic pancreatic resections. Over 400 cases of laparoscopic distal pancreatectomy (LDP) and enucleation (LEn) have been reported in the English literature, largely for benign disease. LDP and LEn have been associated with reductions in blood loss, morbidity, and hospital stay and a greater rate of splenic preservation compared with open surgery. Laparoscopic ultrasound is essential for intraoperative localization of insulinomas because failure of localization is the most common cause for conversion to laparotomy. The role of LDP with en bloc splenectomy and laparoscopic pancreaticoduodenectomy (LPD) for malignancy remains controversial. The majority of LPDs have been performed for malignancy. The short-term results of the limited world experience of 34 reported LPDs appear favorable.

Laparoscopic Pancreatic Resection: The Past, Present, and Future

“…7,17,24,26,44,46 Two deaths after laparoscopic distal pancreatectomies have been reported in a series of 27 patients. 24 One patient with pancreatic cancer died of sepsis and multiorgan failure 19 days after undergoing a distal pancreatectomy, which was initially attempted by a laparoscopic approach but then was converted to an open procedure due to bleeding from the portal vein during a laparoscopic dissection.…”

Clinical outcomes compared between laparoscopic and open distal pancreatectomy

“…These include diagnostic laparoscopic biopsy [1][2][3], explorative laparoscopy for cancer staging [1][2][3], pancreatic drainage [4,5], enucleation [6][7][8], distal pancreatectomy [6,9,10], and pancreaticoduodenectomy [11,12]. Among these procedures, laparoscopic distal pancreatectomy was developed initially because of its technical simplicity due to the absence of numerous anastomoses [13].…”

Laparoscopic Pancreatic Surgery

“…Pseudocysts complicate 5-10% of acute pancreatitis attacks and often arise as a result of disruption of the pancreatic duct in the presence of gland necrosis. Large (≥6cm diameter), persistent (≥6 weeks), and symptomatic pseudocysts are indications for drainage, which is best achieved endoscopically or surgically (Ammori & Baghdadi, 2006). Endoscopic transmural (transgastric or transduodenal) drainage may be possible in some patients with pancreatic pseudocysts, and is best reserved for pseudocysts that complicate chronic pancreatitis (rather than acute pancreatitis) in the head or body of the pancreas, and those with a wall thickness of less than 1cm (Beckingham et al, 1999).…”