Laparoscopic Distal Pancreatic Resection Research Articles

Initial Experience of Laparoscopic Distal Pancreatic Resections: A Single Institution Study with Fifteen Consecutive Cases

Objective: To review the initial experience of outcomes of a consecutive series of laparoscopic distal pancreatic resections are performed at a dedicated cancer hospital. Study Design: Case series. Place and Duration of Study: Department of Surgical Oncology at Tertiary Care Hospital, from Mar 2013 to Feb 2021. Methodology: A retrospective review of consecutive series of patients in which distal laparoscopic pancreatic resections were performed. Data was collected through the Hospital information system (HIS), an electronic hospital database. All patients were discussed in a multidisciplinary team prior to surgery. Results: Fifteen patients, including 4(26.6%) males with a mean age of 49.27±15.2, were planned for laparoscopic distal pancreatectomy. Pathologically, 12(80%) tumours were malignant, while three were benign. The procedure was converted to open in 3 patients. The mean operating time was 4.6±0.57 hours, with an estimated blood loss of around 183±28. 8mls.Mean hospital stay was 5.3±1.5 days. One patient developed a Grade A pancreatic fistula. Recurrence in the liver occurred in two patients, which was managed by systemic adjuvant therapy. However, one of them died later on because of sepsis. Conclusion: A laparoscopic distal pancreatectomy is a safe approach for distal pancreatic tumours, with minimal complications and fast recovery in appropriate cases.

Comparative analysis of open, laparoscopic and robotic distal pancreatic resection: The United Kingdom's first single-centre experience.

Introduction:Laparoscopic distal pancreatectomy (LDP) has potential advantages over its open equivalent open distal pancreatectomy (ODP) for pancreatic disease in the neck, body and tail. Within the United Kingdom (UK), there has been no previous experience describing the role of robotic distal pancreatectomy (RDP). This study evaluated differences between ODP, LDP and RDP.Methods:Patients undergoing distal pancreatectomy performed in the Department of Hepatobiliary and Pancreatic Surgery at the Freeman Hospital between September 2007 and December 2018 were included from a prospectively maintained database. The primary outcome measure was length of hospital stay, and the secondary outcome measures were complication rates graded according to the Clavien–Dindo classification.Results:Of the 125 patients, the median age was 61 years and 46% were male. Patients undergoing RDP (n = 40) had higher American Society of Anesthesiologists grading III compared to ODP (n = 38) and LDP (n = 47) (57% vs. 37% vs. 38%, P = 0.02). RDP had a slightly lower but not significant conversion rate (10% vs. 13%, P = 0.084), less blood loss (median: 0 vs. 250 ml, P < 0.001) and a higher rate of splenic preservation (30% vs. 2%, P < 0.001) and shorter operative time, once docking time excluded (284 vs. 300 min, P < 0.001) compared to LDP. RDP had a higher R0 resection rate than ODP and LDP (79% vs. 47% vs. 71%, P = 0.078) for neoplasms. RDP was associated with significantly shorter hospital stay than LDP and ODP (8 vs. 9 vs. 10 days, P = 0.001). While there was no significant different in overall complications across the groups, RDP was associated with lower rates of Grade C pancreatic fistula than ODP and LDP (2% vs. 5% vs. 6%, P = 0.194).Conclusion:Minimally invasive pancreatic resection offers potential advantages over ODP, with a trend showing RDP to be marginally superior when compared to conventional LDP, but it is accepted that that this is likely to be at greater expense compared to the other current techniques.

Comparative analysis of open, laparoscopic and robotic distal pancreatic resection: An analysis of a single centre experience

Comparative analysis of open, laparoscopic and robotic distal pancreatic resection: An analysis of a single centre experience

SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS IN CHILDREN: 10 YEARS OF EXPERIENCE

Introduction: a solid pseudopapillary tumor (SPPT) of the pancreas is an extremely rare disease occurring in 0.13-2.7% of all pancreatic tumors. This tumor is characterized by a fairly favorable clinical course, with low metastasis potential. The clinical picture is highly non-specific, it is more common in girls of puberty and young women under 30 years of age. The main treatment method is surgical. The purpose of the study is to study the clinical and pathological characteristics of this disease and the possibilities of surgical treatment of patients with this pathology. Material and methods. The analysis of clinical data of patients diagnosed with SPPT in our Institute over the past 10 years (2007-2017). And also therу was reviewed the morphological data of SPPT, types of surgical treatment, results, and complications. Results. For 10 years, SPPT was detected in 24 patients. All patients were girls of puberty from 9 to 17 years. In most cases, the disease was asymptomatic and was diagnosed as an "accidental find" during a medical examination. Two patients had liver metastases. All patients underwent surgical treatment in a different volume: 8 patients - laparoscopic distal pancreatic resection, 3 - gastropancreatoduodenal resections, 3 - pancreatoduodenal resection, 6 - central pancreatic resections, 3 - distal subtotal pancreas resection and 1 - resection of uncinate process of the pancreas with resection of the duodenal wall. Complications occurred in 6 patients: in 4 - postoperative pancreatitis with the formation of pancreatic fistula and in one case - bleeding from the pancreatic branch of the splenic artery and bleeding from the wound surface. The follow-up period lasted from 3 months to 11 years. All patients are alive. Conclusion. SPPT is a rare tumor with a benign course potential. Clinical signs and symptoms are relatively nonspecific. Surgical treatment is the main method of treatment, although it is characterized by a high risk of postoperative complications. In general, the prognosis of this disease is favorable, even in the presence of distant metastases.

The clinical application of laparoscopic distal pancreatic resection (LDP): A report of 23 cases

The clinical application of laparoscopic distal pancreatic resection (LDP): A report of 23 cases

Outcome of Laparoscopic Surgery in Patients with Cystic Lesions in the Distal Pancreas

Context Recent guidelines for the management of cystic lesions of the pancreas recommend observation for selected neoplasms using imaging criteria. However, current imaging modalities lack diagnostic accuracy, and the indication for surgery is debated. Objective In this study we have explored the outcome of laparoscopic distal pancreatic resections in all patients referred with potential pancreatic cystic neoplasms, with histological diagnosis as endpoint. Methods Between 1997 and 2009 all patients referred to our tertiary referral centre having a cystic neoplasm of the distal pancreas accepted for surgery were included in the present observational study. Results A total of 69 patients were included. Sixty-two patients underwent distal pancreatectomies, in whom 19 were spleen-preserving, and 7 enucleations were performed. Two procedures were converted to open technique. The lesions removed in 27 patients (39%) were either malignant or premalignant. The final diagnoses were serous cystic neoplasm (n=29), mucinous cystic neoplasm (n=12), pseudocyst (n=11), solid pseudopapillary neoplasm (n=10), intraductal papillary mucinous neoplasm (n=5) and other (n=2). Overall morbidity was 33%; 56% of the complications were classified as mild. Fistula rate was 10%. One patient died postoperatively from a cerebral haemorrhage. Conclusion Most complications after laparoscopic distal resection of cystic pancreatic lesions are mild, but the proportion of patients with benign lesions (61%) has to be reduced by focused preoperative investigations. Endoscopic ultrasound examination (EUS), enabling aspiration of cyst fluid and fine needle aspiration is an additional option for the preoperative workup. Image: Histological diagnosis of the resected specimens.

77IN - Do Minimal Access and Robotic Surgery Bring Benefit to Neuroendocrine Tumours?

ABSTRACT Minimally invasive surgery has become a well-accepted modality in the management of neuroendocrine tumors (NETs). Laparoscopic approach is the treatment of choice for colorectal NET and it represents a crucial tool for establishing the localization of a lesion after noninvasive studies failed to identify the site of the neoplasm. On the other hand, there is no general consensus regarding the indications for and limitations of laparoscopic surgery for pancreatic NETs. Several studies demonstrated that laparoscopic distal pancreatic resection for NET is safe and feasible providing long-term results comparable with those achieved in open surgery. The main advantage of minimally invasive approach is to reduce the length of hospital stay and to lower significantly blood loss. Several experiences have also reported a significant decrease in the overall complication rate. Laparoscopic pancreaticoduodenectomy is not widely performed due to the associated technical difficulties. However, many studies have shown the effectiveness and safety of this procedure, when performed by expert laparoscopic surgeons. Robotic surgery can overcome the technical difficulties of traditional laparoscopic surgery by restoring three-dimensional vision, enhancing surgeon dexterity and eliminating tremor. Although the role of lymphadenectomy in pancreatic NET has not well established, a robot assisted distal pancreatic resection seems to be associated with a higher median number of resected lymph nodes. Nevertheless, a robotic approach is still limited to highly selected patients and there are many concerns regarding cost-effectiveness of these operations. Conclusions: Laparoscopic surgery is a valid option for NETs. This technique has been widely demonstrated to be safe and feasible with all the advantages of a minimally invasive approach in terms of pain, cosmetic results, length of stay and overall complications. These promising results have to be confirmed by future prospective randomized trials. Disclosure: All authors have declared no conflicts of interest.

Pancreatic Frozen Section in Distal Pancreatectomy: Verona Experience with Harmonic Focus®

Context Pancreatic head resection is performed with low mortality, but morbidity remains high. Extensive preparation, long operating times, intraoperative blood loss and the need for blood transfusions are risk factors for post-operative morbidity. Many authors demonstrated that the use of an ultrasonic dissection device in distal pancreatectomy might significantly reduce operating time, intraoperative blood loss and the need for blood transfusions. Intraoperative frozen section analysis has traditionally played an important role in the surgical management of pancreatic lesions. Currently limited data exist in the surgical literature regarding the accuracy of frozen section analysis for the purpose of determining resectability and assessing final margin status. No data are available about the feasibility of the frozen section performed with the harmonic scalp. Methods A retrospective review was performed for all patients who underwent open, laparoscopic or robotic distal pancreatic resection for cancer (adenocarcinoma or IPMN, or NET) at our institution from 2010 to 2012. The pancreatic transection was effectuated by scalpel or by harmonic scalpel (Harmonic Focus ® ). Frozen section was performed routinely. Results One-hundred and two distal pancreatic resections were performed in our Institution. In 79 patients the pancreatic transection was effectuated by scalpel and in all cases the final pathological diagnosis coincided with the frozen section. In 22 patients, the pancreatic section was performed using the Harmonic Focus ® . Two frozen sections resulted negative for neoplastic cell research but were positive at definitive examination. Conclusion Use of an ultrasonic dissection device (Harmonic Focus ® ) in distal pancreatectomy is safe and feasible. The electrocution of the harmonic scalp could distort the frozen section examination so, where possible, we suggest performing the frozen section with the scalpel.

Transvaginal specimen removal after laparoscopic distal pancreatic resection

Transvaginal specimen removal has been introduced 20years ago but then abandoned. With the advent of transvaginal interventions following the introduction of natural orifice transluminal endoscopic surgery, renewed interest was generated for hybrid procedures with minimal access for the intervention and use of transvaginal (TV) specimen removal. We present the first such series after laparoscopic distal pancreatectomy. In seven subsequent women (median age 48years) with body and tail pancreatic tumors undergoing laparoscopic distal pancreatectomy, the new method of TV specimen removal was applied. The patients' data and the technical successes as well as intra- and postprocedural complications were recorded prospectively. The patients were followed after discharge for gynecological examination. Specimen removal consisting of the pancreas and spleen in five and the pancreas only in two cases was technically successful; no intraoperative complications were encountered. Postoperative complications consisted of one case of intra-abdominal hemorrhage and one case of pancreatic fistula, attributable to the resection and not to TV specimen removal. Gynecological follow-up was normal in all seven patients. The technique of TV specimen removal is feasible and safe also after laparoscopic distal pancreatectomy. It may help to further diminish the access trauma of laparoscopic pancreatic surgery.

Insulinoma: only in adults?—case reports and literature review

Insulinomas first presenting as refractory seizure disorders are well documented in adulthood but rarely found in children. Only a few cases of childhood insulinoma have been reported so far. We report on two adolescents with hyperinsulinaemic hypoglycaemia, initially misdiagnosed as epilepsy and migraine accompagnée, and compare those to other cases published. Localization of insulinoma was challenging and, in one patient, angiography with selective arterial calcium stimulation and hepatic venous sampling in addition to CT and MRI was necessary. In these patients, long-term recovery was achieved by laparoscopic distal pancreatic resection in one and by conventional enucleation in the pancreatic head in the second patient. In contrast to adults, macrosomy and a decrease in school performance were the main symptoms and, during fasting, impaired cognitive function occurred after a relatively short period and at a higher glucose threshold or lower insulin/glucose ratio, respectively. Neuroglycopenic signs may be attributed to behaviour abnormalities or seizure disorders but in children and adolescents may already be caused by insulinoma. In these cases, timely diagnosis as well as tumour resection ensure long-term cure.

Laparoscopic distal pancreatectomy preserving the spleen and splenic vessels for benign and low-grade malignant pancreatic neoplasm.

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is expected to be less invasive than laparoscopic distal pancreatectomy with splenectomy. However, there are few reports regarding the details of the procedure for LSPDP, and its safety remains unclear. This study aimed to evaluate the feasibility and safety of LSPDP. Six patients underwent LSPDP from March 2009 to February 2013 in our center, and their clinical data and outcomes were reviewed retrospectively. A total of six laparoscopic distal pancreatic resections were attempted in four female and two male patients. All of the operations were successful, with an average operative time of 290.7 min (range: 211-377 min) and an average blood loss of 43.5 g (range: 0-142 g). The mean hospital stay was 11.8 days (range: 9-17days). No obvious pancreatic fistulas occurred, although pseudocysts at the stump of the pancreas were recognized in three patients on CT scans performed at 7 days postoperatively. Postoperative pathological examinations revealed two cases of serous cystadenoma in the body and tail of the pancreas, one case of serous oligocystic adenoma, one case of mucinous cystadenoma, one case of neuroendocrine tumor, and one case of solid-pseudopapillary neoplasm. LSPDP is minimally invasive, safe, and feasible for the management of benign pancreatic tail tumors, with the advantages of earlier recovery and less morbidity from complications.

Laparoscopic distal pancreatic resection: Is there a learning curve?

Laparoscopic distal pancreatic resection: Is there a learning curve?

Laparoscopic Distal Pancreatectomy with Splenic Preservation

Minimally invasive techniques are now being vastly applied in the pediatric population. Laparoscopic pancreatic resections were initially performed in the 1990s in the adult population. Since then, laparoscopic pancreatic procedures were applied to pancreatic trauma and tumors of the distal pancreas. Increasing success reported to be ~80% for laparoscopic distal pancreatectomy with splenic preservation in the adult population has helped to pave its application in the pediatric population. As such, laparoscopic pancreatic procedures performed in children included resection of tumors as well as in blunt pancreatic injuries. Here we demonstrate in a 5-minute video a laparoscopic distal pancreatectomy with splenic preservation in a child with cysts in the tail of the pancreas found incidentally after a traumatic fall. Our patient is an 11-year-old boy who was evaluated in the emergency department after a 10-foot fall onto a rubber mat while indoor rock climbing. He complained of nonspecific abdominal and low-back pain. The results of physical examination were unremarkable. Computed tomography (CT) of the abdomen and pelvis was performed based on the mechanism. CT findings demonstrated only a focal cluster of nontraumatic cysts in the tail of the pancreas. Two dominant cysts were 6 mm in diameter. The overall area encompassed by cysts was ~1.9×1.1×1.0 cm. He was discharged home with follow-up magnetic resonance imaging of the abdomen at 4 months to reduce radiation exposure. Results at that time showed no change in the size of the cysts. Follow-up ultrasonography of the abdomen performed at 4 and 8 months demonstrated an increase in the size of the cysts. The patient remained asymptomatic. Due to increase in size of the cyst and concerns of the family, laparoscopic distal pancreatic resection with splenic preservation was elected to be performed. The patient was positioned in a modified right lateral decubitus position with a bean bag and kidney rest. A 10-mm versa step port was placed at the umbilicus. Three 5-mm working ports were placed. The gastrocolic ligament was opened with the LigaSure, and the stomach was retracted superiorly. The pancreas was identified. The left renal vein was identified at the inferior border of the pancreas, and the splenic artery and vein at the superior border. The splenic vessels were dissected, mobilizing the tail of the pancreas. The superior mesenteric artery and vein were identified posteriorly. A window was created to the left of these vessels, and a penrose drain was placed around the tail of the pancreas, used for traction. Using the assistance of radiologic imaging with identification of the superior mesenteric vessels, an area was marked with the cautery to the left of the vessels. An endoscopic gastrointestinal anastomosis 2.5-mm stapler was used to divide across the tail of the pancreas. A Jackson Pratt drain was left in the left upper quadrant. A clear liquid diet was initiated on postoperative day 3 (POD3). Regular diet was introduced on POD4, and the drain was removed. He was discharged on POD5. No competing financial interests exist. Runtime of video: 5 mins

Effect of TachoSil Patch in Prevention of Postoperative Pancreatic Fistula

BackgroundPostoperative pancreatic fistula (POPF) is a severe complication after pancreatic resections. The aim was to assess if application of TachoSil® patch could reduce incidence of postoperative fistulas after laparoscopic distal pancreatic resections. MethodsThis is a retrospective study of prospectively collected data after enucleations and distal pancreatic resections. Patients were divided in two groups: with or without application of TachoSil® patch. Demographic and surgical data were analyzed. ResultsOne hundred twenty-one patients with distal pancreatic resections without additional resections were identified among 230 patients operated by laparoscopic approach at our institution since 1998. They were divided into two groups. In group 1 (n = 48), TachoSil® patch was not applied while in group 2 (n = 73), the pancreatic stump was covered with TachoSil®. Postoperative fistulas were registered in 8% (4/48) and 12% (9/73) in groups 1 and 2, respectively. The median duration of postoperative hospital stay in group 1 was 5.5 (2–35) days compared with 5 (2–16) days in group 2. No significant difference in surgical outcomes was found. ConclusionsThe application of the TachoSil® patch did not affect either occurrence of POPF or duration of postoperative hospital stay. Routine use of TachoSil® patch to prevent pancreatic fistulas does not provide clinically significant benefit.

EUS-guided tattooing before laparoscopic distal pancreatic resection (with video)

Precise localization of small pancreatic tumors during laparoscopic distal pancreatectomy (LDP) can be difficult because of decreased tactile ability of laparoscopy and the homogeneous appearance of the pancreas and surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection and preserving healthy pancreatic tissue. EUS-guided fine-needle tattooing (EUS-FNT) of a pancreatic lesion before LDP has been described in single case reports, but no large series have reported its effectiveness in patients undergoing LDP. To assess the feasibility, safety, and efficacy of EUS-FNT in consecutive patients undergoing LDP. Retrospective cohort study. Tertiary-care referral hospital. This study involved 30 consecutive patients who underwent LDP from 2008 to 2010. Thirteen had EUS-FNT followed by LDP, and 17 had LDP alone. LDP or EUS-FNT with a sterile carbon-particle tattoo followed by LDP. The following features were examined: the technical success and complication rates of EUS-FNT, visibility of the tattoo at the time of laparoscopy, durability of the tattoo, and pathologic absence of tumor at the resection margin. The final pathology of pancreatic lesions of patients who had EUS-FNT was similar to those who had LDP alone. The median resected tumor size was significantly larger for the LDP-alone patients (median 4.0 cm vs 1.3 cm; P = .03). Thirty-one percent (4/13) of lesions in the EUS-FNT group were not visualized by prior preoperative pancreatic protocol CT. EUS-FNT was feasible in all 13 patients at laparoscopy, with R0 resection and negative final pathology margins in all cases. The tattoo was visible in all 13 EUS-FNT cases, with mean time from EUS-FNT to surgery of 20.3 days (range, 3-69 days). There were no significant complications associated with EUS-FNT. Small, retrospective, single-center study. Preoperative EUS-FNT of lesions was technically feasible and safe, and it assisted in the localization of lesions in patients before LDP. The carbon particle tattoo was durable and visible in all cases.

Laparoscopic distal pancreatic resection: Our own experience in the treatment of solid tumors

A laparoscopic resection is a new treatment for pancreatic tumors. Articles by surgeons who are writing about their first experience in carrying out this treatment have appeared in the literature, reporting that laparoscopic surgery can be used for the treatment of pancreatitis, benign lesions, and solid tumors. This is a study of three patients with pancreatic tumors who were treated by means of a laparoscopic distal pancreatic resection with preservation of the spleen and splenic vessels. In three cases a laparoscopic distal resection was performed for the tumor. The histologic examinations showed one insulinoma and two mucinous cystadenomas. No patient suffered from intra- or postoperative complications. A laparoscopic resection of the distal pancreas is a new alternative for the treatment of pancreatic tumors. This method takes advantage of the benefits of minimally invasive surgery.

Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre

Laparoscopic pancreatic surgery has been slow to gain wide acceptance due to the complex pancreatic anatomy and physiology. The aim of this study was to analyze our preliminary results and highlight the impact of centralization on surgeon workload and pancreatic surgical innovation. A retrospective analysis was performed on all patients who underwent laparoscopic distal pancreatectomy from May 2007 to October 2008. Laparoscopic distal pancreatectomy was performed in 17 patients during that period. Median operative time was 180 min (range 120-300 min). Median blood loss was 100 ml (range 50-500 ml). Splenectomy was performed in 12 patients. None of the patients was converted to open operation. All patients were kept in high-dependency unit for median duration of 1 day (range 0-1 day). One patient with previous cardiac disease was kept in intensive therapy unit for one night, but discharged home on 7th postoperative day without any complications. Postoperative recovery was uneventful in 13 patients, while four patients had pancreatic leak. One pancreatic leak was observed in the last 11 patients, in which pancreatic stump was oversewn. In three patients, pancreatic leaks (PL) were minor and settled with conservative management, while one patient needed a computed tomography (CT)-guided drainage and subsequent minilaparotomy for wash out of the intra abdominal collection. None of the patients died in this series. Median hospital stay was 5 days (range 4-7 days). Laparoscopic distal pancreatic resection is feasible, safe, and efficient. However, this surgery should only be performed in specialized centres with extensive experience in pancreatic and laparoscopic surgery. Oversewing the pancreatic stump after transaction with Endostapler may reduce the incidence of pancreatic leak. Centralization of pancreatic surgery has a positive impact on building up surgical expertise, resulting in obvious benefits for both patients and institutions.

Minimal-invasive Resektion neuroendokriner Pankreastumoren

Pancreatic endocrine tumors (PET) are a heterogeneous group of lesions with an annual incidence of 0.1 to 0.4 per 100,000. They account for 2-4% of pancreatic neoplasms. Due to their mostly small size, some are suited to a laparoscopic approach. Preoperative localization, intraoperative laparoscopic ultrasonography, and considerable experience in pancreatic endocrine surgery and sophisticated laparoscopic techniques are essential for successful laparoscopic treatment of these tumors. If definite or highly suspicious signs of malignancy occur, a conventional open approach should be preferred. Insulinomas and small nonfunctioning PET in the pancreatic body or tail or near the surface of the pancreatic head and not in contact with the portal vein or the main pancreatic duct are suited to a laparoscopic approach. Patients with MEN1 who have insulinomas or small nonfunctioning PET may also benefit from a laparoscopic spleen-preserving distal pancreatic resection. Neither sporadic and MEN1-associated gastrinomas nor the very rare glucagonomas and vasoactive intestinal peptide-producing tumors (vipomas), which are often large and malignant, should also be tackled laparoscopically.

Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution

Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic distal pancreatic resection (LDPR) with open distal pancreatic resection (ODPR). This study aimed to compare clinical outcomes for LDPR and ODPR performed at a single institution. For this study, 93 patients with benign pancreatic disease underwent LDPR, and 35 patients with benign pancreatic disease underwent ODPR. Patient demographic characteristics, operative times, perioperative complications, length of hospital stay, and return to normal diet were compared retrospectively between the two groups. The LDPR and ODPR groups had the same demographic characteristics. The median operative time was 195 min in the LDPR group and 190 min in the ODPR group (p>0.05). The rate of spleen preservation was higher in the LDPR group (40.8%) than in the ODPR group (5.7%) (p<0.05) No operative mortality occurred in either group. The overall complication rate was 24.7% in the LDPR group and 29% in the ODPR group (p>0.05). The rate of pancreas-related complications was 11.8% in the LDPR group and 17.2% in the ODPR group (p>0.05). Pancreatic fistula developed in 8.6% of the LDPR group and in 14.3% of the ODPR group (p>0.05). Bowel movement return to normal and resumption of normal diet were achieved 2.8+/-1.3 days after the operation in the LDPR group and 4.5+/-1.6 days after the operation in the ODPR group (p<0.05). The median duration of hospital stay was 10 days for the LDPR group, which was significantly shorter than the 16 days for the ODPR group (p<0.01). The use of LDPR for benign lesions of the distal pancreas is feasible and safe. The LDPR procedure is associated with operative times and complication rates similar to those for ODPR, but LDPR has the advantages of an earlier return to normal bowel movements and normal diet and shorter hospital stays than ODPR.

454 Standardization of Laparoscopic Distal Pancreatic Resection (LapDPR) with Regional Lymphadenectomy in Malignant Pancreatic Neoplasms (MPN)

454 Standardization of Laparoscopic Distal Pancreatic Resection (LapDPR) with Regional Lymphadenectomy in Malignant Pancreatic Neoplasms (MPN)