Minimally invasive pancreatic surgery—where are we going?

Sahakyan, Mushegh А.; Labori, Knut Jørgen; Primavesi, Florian; Søreide, Kjetil; Stättner, Stefan; Edwin, Bjørn

doi:10.1007/s10353-019-0576-y

Cited by 5 publications

(5 citation statements)

References 68 publications

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“…On the one hand, there was the conceptual problem of whether in complex and demanding surgical operations such as pancreatic resections the size of the incision can truly be considered the main contributor to surgical trauma. On the other hand, some peculiar aspects of pancreatic surgery have initially hampered the widespread diffusion of the minimally invasive approach in this field: the peculiar retroperitoneal location of the pancreas, its delicate texture and proximity to major vessels, the complexity of the dissection, the concerns regarding oncological safety in the case of malignancy, the difficulty of the anastomotic components, and the still relatively high morbidity and mortality that characterize pancreatic resections [6][7][8][9][10] . Another more practical matter is the relative rarity of pancreatic diseases and the complexity of most cases, which make them not suitable to be approached minimally invasively by surgeons at the beginning of their learning curve; the result is an even longer time to reach proficiency and an acceptable morbidity and mortality rate [11] .…”

Section: Mis In the Pancreatic Surgery Field: A Steep Pathmentioning

confidence: 99%

What role does hand-assistance have in minimally invasive pancreatic surgery?

Donisi¹,

Zerbi²

2021

MIS

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Surgery poses an important stress on the patient from both physical and psychological points of view per se. It has become clearer with time that, regardless of the type of surgical operation, a smaller surgical incision could reduce the operation-induced stress. With advancements in technology, great efforts have been made in trying to reduce this burden on the patient, leading to the development of minimally invasive surgery (MIS) [1,2] . MIS has gained increasing support since its introduction and has undergone continuous improvements and evolutions to the point of becoming, nowadays, the standard of care for many surgical procedures such as cholecystectomy, adrenalectomy, splenectomy, and fundoplication. MIS encompasses several different approaches which have in common the aim of decreasing the impact of the surgical operation on the patient. The first approach to be developed and widely accepted in clinical practice was laparoscopy. Among the well-established advantages of laparoscopic surgery, we have decreased pain, shorter length of stay, faster postoperative recovery, and a better visualization of secluded anatomical spaces which would otherwise require a large incision to be correctly exposed [3] . All of this comes at the price of decreased dexterity, diminished tactile feedback, and inherent limitations posed by restricted degrees of freedom of laparoscopic instrumentation, which may result in a longer operative time compared to the open approach for complex surgical procedures [4] . In recent years, an alternative to the laparoscopic technique has been proposed with the introduction of robotic platforms in surgery. Potential advantages of robotic surgery are filtration of tremors, better dexterity, higher degrees of freedom with the EndoWrist system, and better Not applicable.

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Section: Mis In the Pancreatic Surgery Field: A Steep Pathmentioning

confidence: 99%

What role does hand-assistance have in minimally invasive pancreatic surgery?

Donisi¹,

Zerbi²

2021

MIS

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“…The incidence of PDAC is higher in more developed countries and in the elderly population [1,3]. Despite the introduction of new therapeutic approaches combining multimodal treatment protocols and surgical resection, at only 8%, PDAC has the lowest 5-year survival rate of all cancer types [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Fibroblast growth factor 8 overexpression is predictive of poor prognosis in pancreatic ductal adenocarcinoma

et al. 2020

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Summary Background Despite distinctive advances in the field of pancreatic cancer therapy over the past few years, patient survival remains poor. Fibroblast growth factors 8 (FGF8) and 18 (FGF18) both play a role in modulating the activity of malignant cells and have been identified as promising biomarkers in a number of cancers. However, no data exist on the expression of FGF8 and FGF18 in pancreatic ductal adenocarcinoma (PDAC). Methods Protein expression levels of FGF8 and FGF18 in postoperative specimens of neoadjuvantly treated and primarily resected patients were investigated using immunohistochemistry. Immunostaining scores were calculated as the products of the staining intensity and the staining rate. Scores exceeding the median score were considered as high expression. Results Specimens from 78 patients with PDAC were available and met the eligibility criteria for analysis of protein expression using immunohistochemistry. 15 (19.2%) patients had received neoadjuvant chemotherapy. High protein levels of FGF8 and FGF18 were detected in 40 (51.8%) and 33 (42.3%) patients, respectively. Kaplan–Meier analysis demonstrated significantly shorter overall survival in patients with high expression of FGF8 (p = 0.04). Multivariable Cox proportional hazard regression models revealed that high expression of FGF8 (Hazard ratio [HR] 0.53, 95% Confidence interval [CI] 0.32–0.89, p = 0.016) was an independent prognostic factor for diminished overall survival in patients with PDAC. By contrast, no statistical significance was found for FGF18 overexpression. In addition, the FGF8 protein level correlated with the factor resection margin (p = 0.042). Conclusion FGF8 is a promising target for new anticancer therapies using FGF inhibitors in pancreatic ductal adenocarcinomas.

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“…These applications include laparoscopic resection and percutaneous ablation of pancreatic lesions. However, minimally-invasive interventions require highly experienced surgeons and interventional radiologists due to multiple critical structures surrounding the pancreas [1] – [3] . These, among others, include vascular structures such as the superior mesenteric artery, celiac artery (CA), portal vein (PV), and superior mesenteric vein, as well as the duodenum, common bile duct (CBD), and pancreatic duct.…”

Section: Introductionmentioning

confidence: 99%

A Multimodal Pancreas Phantom for Computer-Assisted Surgery Training

Eigl

Haslebacher

Müller

et al. 2020

IEEE Open J. Eng. Med. Biol.

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Training of surgical residents and the establishment of innovative surgical techniques require training phantoms that realistically mimic human anatomy. Because animal models have their limitations due to ethical aspects, costs, and the required efforts to set up such training, artificial phantoms are a promising alternative. In the field of image-guided surgery, the challenge lies in developing phantoms that are accurate both anatomically and in terms of imaging properties, while taking the cost factor into account. With respect to the pancreas, animal models are less suitable because their anatomy differs significantly from human anatomy and tissue properties rapidly degrade in the case of ex vivo models. Nevertheless, progress with artificial phantoms has been sparse, although the need for innovative, minimally invasive therapies that require adequate training is steadily increasing. Methods: In the course of this project, an artificial pancreas phantom that is compatible with basic electrosurgical techniques was developed with realistic anatomic and haptic properties, computed tomography, and ultrasound imaging capabilities. This article contains step-by-step instructions for the fabrication of a low-cost pancreatic phantom. The molds are also available for download in a 3D file format. Results: The phantom was successfully validated with regard to its computed tomography and ultrasound properties. As a result, the phantom could be used in combination with a state-of-the-art computer-assisted navigation system. The resection capabilities were positively evaluated in a preclinical study evaluating endoscopic resections using the navigation system. Finally, the durability of the phantom material was tested in a study with multiple needle insertions. Conclusion: The developed phantom represents an open-access and low-cost durable alternative to conventional animal models in the continuous process of surgical training and development of new techniques.

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Minimally invasive pancreatic surgery—where are we going?

Cited by 5 publications

References 68 publications

What role does hand-assistance have in minimally invasive pancreatic surgery?

What role does hand-assistance have in minimally invasive pancreatic surgery?

Fibroblast growth factor 8 overexpression is predictive of poor prognosis in pancreatic ductal adenocarcinoma

A Multimodal Pancreas Phantom for Computer-Assisted Surgery Training

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