Technique of Pancreatic Resection

Abstract

Laparoscopic pancreatic resection was first introduced in 1994 by Gagner and Pomp [1] and Cushieri [2]. Using the criteria of Cushieri and Jakimowicz [3], the probable benefit of minimally invasive surgery over conventional open surgery depends on the ratio of access to procedural trauma. In pancreatoduodenectomy, the access trauma forms only a small component of the total operative insult to the patient. Therefore, laparoscopic approach is to be recommended only when its postoperative course can promise a better outcome than that of the current open approach. However, favorable postoperative results in terms of less pain, less analgesia requirement, early return of bowel function, and shorter hospital stay, in patients who underwent laparoscopic pancreatic resection for left-sided pancreatic lesions have been consistently reported [4–20]. The majority reports on laparoscopic pancreatic surgery (LPS) are often based on limited experience with short-term outcome. Recently, a multi-institutional European study (25 European Centers), including 127 patients, demonstrated that laparoscopic pancreatic resection is feasible and safe in selected groups of presumed benign pancreatic lesions requiring enucleation procedures or left-sided pancreatic resections [18]. A point of criticism of this study was that only four centers (16%) reported more than 10 patients. Some authors have suggested that malignant pancreatic neoplasms are a contraindication to laparoscopic resection because of concerns on the lack of radicality of the resection and the inferior oncological outcomes [5]. However, we have recently demonstrated the feasibility, safety, and long-term outcome of the laparoscopic approach in 103 patients with benign, premalignant, and overt malignant lesions of the pancreas. To our knowledge, this is the largest single-institution series on this subject to date [21].