Laparoscopic Pancreatectomy Research Articles

Patency evaluation after venous resection and reconstruction with autologous peritoneum in laparoscopic pancreatectomy

BackgroundConcomitant venous resection during pancreatectomy for pancreatic space-occupying lesions with veinous involvement is increasingly performed to achieve oncological resection. This study aims to report a single-center experience in peritoneal patch graft for vascular reconstruction during laparoscopic pancreatectomy. MethodsA retrospective analysis of all 6 patients who underwent laparoscopic pancreatectomy as well as the venous reconstruction with autologous peritoneum graft were compared with the control group, 8 patients who received Laparoscopic pancreaticoduodenectomy with venous resection and primary anastomosis. Postsurgical complications and outcomes were evaluated. We specifically assessed the reconstructed venous patency ratio by Cross-sectional Area Algorithm which was based on post-surgical CT-Venograms, thereafter the overall patency ratio was compared with the control group. ResultsAll 6 patients underwent venous resection and reconstruction using peritoneum patches of appropriate size, which includes 5 cases of lateral patch repairing and 1 case of tubular repairing. There are no significant differences noticed in post-surgical complications and outcomes between the peritoneum graft group and the control group. However, most of the peritoneum graft cases showed stenosis or complete occlusion after surgery. Partial venous stenosis or complete occlusion did not cause abnormal liver function as newly formed venous collaterals were early detected and progressively robust. ConclusionsUse of peritoneal patch as a venous substitute during the laparoscopic pancreatectomy contains satisfied operability and safety. However, the post-surgical reconstructed venous patency was an issue that need to be noticed. Overall, the peritoneum repairing technique is a considerable choice that assisted the oncological resection in certain situations.

Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats.

To describe a laparoscopic technique and outcome for partial pancreatectomy in cats. Prospective cohort study. Nine cats. Laparoscopic pancreatectomy was performed using a single incision laparoscopic surgery port and an additional 5.5 mm port. The left pancreatic limb was dissected, sealed and divided at the level of the splenic vein insertion to the portal vein using a harmonic device. Surgical time and complications were recorded. The weight and length of the resected pancreatic limb was recorded. Pre- and postoperative trypsin-like immunoreactivity (TLI), pancreatic lipase immunoreactivity (PLI), and hemoglobin A1C were documented. Laparoscopic partial pancreatectomy was performed successfully in all cats. One grade 1 intraoperative complication occurred (1/9; 11%) resulting in minor hemorrhage from a caudal splenic vein branch. A grade 2 postoperative complication occurred within 3 days after surgery in one cat (1/9; 11%), involving localized, sterile peritonitis in the region of the pancreatic angle. Signs resolved with conservative management. No cats exhibited signs of pancreatitis postoperatively. Long-term, mean TLI decreased by 37% ± 38% (p = .03) following partial pancreatectomy, while PLI and A1C were unchanged. All cats were alive and clinically well at last follow-up 250 to 446 days following surgery. Laparoscopic partial pancreatectomy using a harmonic device is effective in cats, and offers a minimally-invasive alternative to open surgical pancreatectomy techniques. Laparoscopic pancreatectomy of the left limb results in adequate exocrine and endocrine function in the long-term.

Successful resection of port site recurrence of pancreatic ductal adenocarcinoma after laparoscopic distal pancreatectomy

BackgroundThere are many reports of port site recurrence after laparoscopic surgery for various types of cancer. However, only two cases of port site recurrence after laparoscopic pancreatectomy have been reported to date. We herein report a case of port site recurrence after laparoscopic distal pancreatectomy.Case presentationA 73-year-old woman was diagnosed with pancreatic tail cancer and underwent laparoscopic distal pancreatectomy with splenectomy. Histopathological examination revealed pancreatic ductal carcinoma (pT1N0M0 pStage I). The patient was discharged on postoperative day 14 with no complications. However, 5 months after surgery, computed tomography showed a small tumor at the right abdominal wall. No distant metastasis had appeared after 7 months of follow-up. Under the diagnosis of port site recurrence without any other metastases, we resected this abdominal tumor. Histopathological examination showed port site recurrence of pancreatic ductal carcinoma. No recurrence was observed 15 months postoperatively.ConclusionsThis is the report of successful resection of port site recurrence of pancreatic cancer.

Pancreatectomía izquierda laparoscópica: ¿la sistematización de la técnica es de utilidad?

Background: Laparoscopic left pancreatectomy is a high complexity procedure that should be systematized to reduce complications and operative time. Objective: To describe the results achieved with a systematized technique for laparoscopic pancreatectomy and splenectomy. Materials and methods: We selected patients who were candidates for distal pancreatectomy and splenectomy between 2007 and 2022. Patients with systemic diseases were excluded. The laparoscopic technique consists of ligating the short vessels as a first step, then dissecting and cutting the splenic artery, leaving the section of the vein as the last surgical gesture to avoid venous congestion of the spleen. Perioperative, intraoperative and postoperative variables were analyzed. Results: A total of 155 patients were analyzed, 90 underwent laparoscopy and 65 underwent conventional surgery. Mean operative time was 168 minutes The operative time in the laparoscopic approach decreased from case 30 onwards. Mortality rate was 1.12%. The incidence of pancreatic fistula was 41%. Need for intraoperative transfusion occurred in 10.7% of the patients and the conversion rate was 13.3%. Conclusion: The systematization of the technique of pancreatic laparoscopy is essential to reduce surgical times, ensure safe dissections and performe more complex procedures.

The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic.

There is no standardization in videos uploaded to Youtube. Were the videos capable of contributing to adequate technical quality and surgical training? We are aiming to answer these questions in this paper. It is a cross-sectional study. In January 2022, we searched the Youtube platform using the keyword "distal pancreatectomy." The substantiality, transparency, reliability, quality, popularity and educational values of the video content were evaluated after exclusion criteria. These parameters were evaluated using we the modified Journal of American Medical Association benchmark criteria, Global Quality Score (GQS), Video Power Index, modified laparoscopic pancreatectomy scoring system. The videos uploaded after the pandemic had a statistically significant higher GQS score (P < .001). Video Power Index, like GQS, had a statistically significant difference before and after the pandemic. (P = .046). There was no significant difference in the evaluation of the reliability and substantiality. Until the development of Youtube videos is completed, peer-reviewed, more reliable and content-rich online education platforms should be preferred in the first place. Care should be taken to watch selected videos on Youtube videos.

Single-port laparoscopic pancreaticoduodenectomy.

Performing a single-port laparoscopic pancreatectomy is technically challenging. Single-port laparoscopic pancreaticoduodenectomy (SPLPD) is rarely reported in English literature. Eighty-seven cases of laparoscopic pancreaticoduodenectomy (LPD) were performed by a single surgical team in the Department of Pancreatic Surgery, West China Hospital, Sichuan University between February 2020 and December 2020. Among these, 13 cases of LPD (group 1) were performed using a single-port device. Basing on the same inclusion and exclusion criteria, 68 cases of LPD performed using traditional 5-trocar were included as a control group (group 2). The patient's demographic characteristics, intraoperative, and postoperative variables were prospectively collected and retrospectively analyzed. Five men and eight women were included in the SPLPD group. The median age of these patients was 57years. The patients who underwent SPLPD required a longer operative time (332.7 ± 38.1min vs. 305.8 ± 64.7min; p = 0.03) than those in the LPD group. The estimated blood loss, conversion rate, blood transfusion rate, time to oral intake, postoperative hospital stays, and perioperative complications were comparable between the two groups. The short-term oncological outcomes, such as R0 rate and lymph node harvested, were comparable between the two groups. The 90-day mortality of all patients was zero. SPLPD is a safe and feasible procedure for well-selected patients in an experienced minimally invasive pancreatic surgery team. SPLPD may provide several potential advantages, such as the requirement of fewer trocars, fewer abdominal complications, and reduced participation of assistants than conventional LPD.

Converted laparoscopic distal pancreatectomy: is there an impact on patient outcome and total cost?

PurposeRecent studies have reported worse outcomes of converted laparoscopic distal pancreatectomy (CLDP) with respect to total laparoscopic (TLDP) and open (ODP). The aim of the study was to evaluate the impact of conversion on patient outcome and on total cost.MethodsPatients requiring a conversion (CLDP) were compared with both TLDP and ODP patients. The relevant patient- and tumour-related variables were collected for each patient. Both intra and postoperative data were extracted. Propensity score matching (PSM) analysis was carried out to equate the groups compared.ResultsTwo hundred and five patients underwent DP, 105 (51.2%) ODPs, 81 (39.5%) TLDPs, and 19 (9.3%) CLDPs. After PSM, 19 CLDPs, 38 TLDPs, and 38 ODPs were compared. Patients who underwent CLDP showed a significantly longer operative time (P < 0.001), and an increase in blood loss (P = 0.032) and total cost (P = 0.034) with respect to TLDP, and a significantly longer operative time (P < 0.001), less frequent postoperative morbidity (P = 0.050), and a higher readmission rate (P = 0.035) with respect to ODP.ConclusionTotal laparoscopic pancreatectomy was superior regarding operative findings and total costs with respect to CLDP; ODP showed a higher postoperative morbidity rate and a lower readmission rate with respect to CLDP. However, the reasons for the readmission of patients who underwent CLDP were mainly related to postoperative pancreatic fistula (POPF) grade B which is usually due to pancreas texture. Thus, the majority of distal pancreatectomies can be started using a minimally invasive approach, performing an early conversion if necessary.

Laparoscopic pancreatectomies for borderline tumors with major venous resections.

Resection of the portal vein or superior mesenteric vein infiltrated by the pancreatic cancer is currently a standard during open pancreatic surgery for cancer. When found intraoperatively it often leads to conversion. Nowadays, research data for laparoscopic pancreatectomies with major venous resections and reconstructions are scarce. To present our own results of laparoscopic total pancreatectomies, pancreaticoduodenectomy and distal pancreatectomies (RAMPS) performed for cancer with major venous resection and reconstructions of the portal system. This is a retrospective study of our own clinical material of consecutive patients treated for adenocarcinoma of pancreas who underwent laparoscopic pancreatectomies with major venous resection and reconstruction in 2020 and 2021. The study included 6 females and 2 males in median age of 68 years (56-77). 6 tumors were located in the pancreatic head, 1 in the pancreatic neck and 1 in the pancreatic body. Surgical procedures included 5 total pancreatectomies, 2 RAMPS and 1 Whipple pancreaticoduodenectomy. There were no conversions. Median time of vascular closure was 55.5 (41-70) min. Median blood loss was 500 (250-900) ml. Median length of hospital stay (LOS) was 18.5 (11-34) days. We observed no complications related directly to vascular resection. Laparoscopic approach for pancreatectomies with portal or superior mesenteric vein resections could be a safe and feasible approach in the hands of an experienced surgeon.

Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution

ObjectiveTo investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques.MethodsWe retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted.ResultsTotally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3–63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7–24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0–1000.0) vs. 50.0 (20.0–200.0) ml P < 0.001 and 100.0 (20.0–300.0) vs. 50.0 (20.0–200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041).ConclusionsOverall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.

Congenital hyperinsulinism: recent updates on molecular mechanisms, diagnosis and management.

Congenital hyperinsulinism (CHI) is a rare disease characterized by an unregulated insulin release, leading to hypoglycaemia. It is the most frequent cause of persistent and severe hypoglycaemia in the neonatal period and early childhood. Mutations in 16 different key genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, UCP2, HNF4A, HNF1A, HK1, KCNQ1, CACNA1D, FOXA2, EIF2S3, PGM1 and PMM2) that are involved in regulating the insulin secretion from pancreatic β-cells have been described to be responsible for the underlying molecular mechanisms of CHI. CHI can also be associated with specific syndromes and can be secondary to intrauterine growth restriction (IUGR), maternal diabetes, birth asphyxia, etc. It is important to diagnose and promptly initiate appropriate management as untreated hypoglycaemia can be associated with significant neurodisability. CHI can be histopathologically classified into diffuse, focal and atypical forms. Advances in molecular genetics, imaging techniques (18F-fluoro-l-dihydroxyphenylalanine positron emission tomography/computed tomography scanning), novel medical therapies and surgical advances (laparoscopic pancreatectomy) have changed the management and improved the outcome of patients with CHI. This review article provides an overview of the background, clinical presentation, diagnosis, molecular genetics and therapy for children with different forms of CHI.

Laparoscopic versus open central pancreatectomy: A propensity score-matched analysis in a single center

Laparoscopic versus open central pancreatectomy: A propensity score-matched analysis in a single center

Laparoscopic pancreatectomy for pancreatic cancer with advanced energy device (LigaSure Maryland jaw device)

Pancreatic cancer is well known to be one of the most lethal malignant diseases in gastrointestinal tract. As a monotherapy, margin-negative radical pancreatectomy is regarded as the most potent anticancer treatment. However, to enhance the oncologic efficacy of curative resection, postoperative chemotherapy should be considered. As a matter of fact, it is estimated that pancreatic cancer will be the second most common cancer-related human mortality in 2030, which will be main theme regarding human health issue. With advance of pancreatic surgery, developing method for early diagnosis, understanding tumor biology, and introduction of new potent chemotherapeutic agents, pancreatic cancer is expected to face new paradigm in near future. Especially in treating pancreatic cancer, surgical extirpation is very important. Due to anatomical complexity, and surgical difficulty, laparoscopic radical pancreatectomy in treating pancreatic cancer is still controversial. However, currently available data are showing its feasibility, safety, and equivalent oncologic outcomes comparing with open surgical approach in well selected patients. There are potential theoretical advantages of laparoscopic pancreatectomy. Early recovery with less surgical stress is expected to provide the patients with appropriate patients' condition to receive the postoperative adjuvant chemotherapy, which is inevitable requirement for the long-term survival. Therefore, in performing laparoscopic radical pancreatectomy for pancreatic cancer, surgeons need for effective energy device in dissecting the pancreas for safe and effective margin-negative resection. It is thought that LigaSure Maryland jaw device can be appropriate in performing laparoscopic radical pancreatectomy for pancreatic cancer due to following several reasons; 1) Burst pressure 2) Temperature 3) Nano-coating 4) Blunt dissection. Obtaining superior mesenteric artery (SMA) lateral margin is crucial in pancreatic head cancer. Very narrow space is allowed for securing SMA lateral margin. Alternative advanced energy device, Sonicision curved jaw cordless ultrasonic dissection system, can enhance the surgical performance and safety. Thin and small curved blade (0.8 mm-1.7 mm) can provide easy access to the tight space with less potential thermal damage near the major vascular structure. In this presentation, I would like to discuss our clinical practice of laparoscopic pancreatectomy for pancreatic cancer with advanced energy device.

Cost-effectiveness of open versus laparoscopic pancreatectomy: A population-based study using data from the Korea National Health Insurance Service

It has been shown that laparoscopic pancreatic resection (LPR) is comparable to open pancreatic resection (OPR). However, cost-effectiveness analysis of LPR is rare. We performed a population-based study on the cost-effectiveness of LPR versus OPR. Data of 9,255 patients who received pancreaticoduodenectomy (PD) (66.8%) and distal pancreatectomy (DP) (33.2%) from 2016 to 2018 were retrieved from the National Health Insurance Service. Events after pancreatectomy were categorized as no complications, intervention, reoperation, and death. Probabilities of each event and average cost during index admission (IA) and postoperative 1 year (Po1Y) were utilized to calculate incremental cost effectiveness ratio (ICER), the cost difference between two interventions divided by quality adjusted life year (QALY). QALY, a function of length and quality of life, was measured with utility values determined by researching literature. LPR was performed in 8.2% of PDs and 17.8% of DPs. For PD, LPR was associated with an increase of 0.0404 QALYs for IA and 0.0127 QALYs for Po1Y compared with OPR. Incremental cost was 421,917 KRW for IA and -1,860,579 KRW for Po1Y, leading to an ICER of 10,437,432 KRW per QALY gained for IA and -146,752,689 KRW per QALY gained for Po1Y. For DP, LPR improved 0.0909 QALYs for IA and 0.0469 QALYs for Po1A. Incremental cost was -1,632,107 KRW for IA and -7,730,674 KRW for Po1Y, leading to an ICER of -17,954,499KRW per QALY gained for IA and -164,990,346 KRW for Po1Y. Except initial higher cost of LPR, LPR was a cost-effective alternative to OPR for PD and DP.

Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model

Introduction several pancreatectomy techniques in rats have been described and utilized for research concerning the pancreas endocrine and exocrine functions. However, we did not find a description of any kind of laparoscopic pancreatectomy in rats in the consulted databases. The objective of this study is to describe a laparoscopic splenic lobe pancreatectomy in rats. Methods ten Wistars rats weighting more then 300 g were operated for standardizing the laparoscopic pancreatosplenectomy technique, aided by previous descriptions of laparoscopic splenectomy and open pancreatectomy in rats. Adjustments have been progressively adopted for technical refinement. Results In five animals a low-cost rat laparoscopic set was used. In other five animals we used a standard laparoscopic set. Three rats died early due to different causes: transection of the gastroesophageal junction, hemorrhagic shock and inadvertent colonic injury. The postoperative period of the other seven rats was uneventful until the seventh postoperative day. Discussion laparoscopic distal pancreatectomy and splenectomy in rats is feasible and safe, even with a low-cost set, in which the results were alike the standard laparoscopic set.

Use of Transumbilical Incision as an Organ Removal Site in Laparoscopic Pancreatectomy.

To evaluate complications and risk factors associated with transumbilical incision as an organ removal site in laparoscopic pancreatectomy (LP). In total, 52 patients who underwent LP between 2009 and 2017 were included in this study. The development of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia was recorded. None of the patients had SSI. However, three (5.77%) presented with transumbilical incisional hernia. No variables were significantly associated with the risk of transumbilical incisional hernia. No evident risk factors correlated with hernia formation. Hence, incisional hernia might have occurred at a certain probability. In some cases, it was caused by technical problems. However, the use of transumbilical incision as an organ removal site was feasible, and a new incision for organ removal alone was not required.

The current status and future directions of robotic pancreatectomy.

Robotic surgery has emerged as an alternative to laparoscopic surgery and it has also been applied to pancreatectomy. With the increase in the number of robotic pancreatectomies, several studies comparing robotic pancreatectomy and conventional open or laparoscopic pancreatectomy have been published. However, the use of robotic pancreatectomy remains controversial. In this review, we aimed to provide a comprehensive overview of the current status of robotic pancreatectomy. Various aspects of robotic pancreatectomy and conventional open or laparoscopic pancreatectomy are compared, including the benefits, limitations, oncological efficacy, learning curves, and costs. Both robotic pancreatoduodenectomy and distal pancreatectomy have favorable or comparable outcomes to conventional procedures, and robotic pancreatectomy has the potential to be an alternative to open or laparoscopic procedures. However, there are still several disadvantages to robotic platforms, such as prolonged operative duration and the high cost of the procedure. These disadvantages will be improved by developing instruments, overcoming the learning curve, and increasing the number of robotic pancreatectomies. In addition, robotic pancreatectomy is still in the introductory period in most centers and should only be used in accordance with strict indications.

Laparoscopic total pancreatectomy with splenic vessels resection for pancreatic metastasis from renal cell carcinoma.

Laparoscopic total pancreatectomy with splenic vessels resection for pancreatic metastasis from renal cell carcinoma.

Laparoscopic pancreatectomy for cancer in high volume centers is associated with an increased use and fewer delays of adjuvant chemotherapy

BackgroundThis study aimed to investigate the relationship between hospital case volume, surgical approach and AC-use in patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC). MethodsPatients were divided into quartiles by institutional pancreatectomy case volume, resection type (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or total pancreatectomy [TP]) and surgical approach (laparoscopic vs. open). The rates and contributing factors of AC administration and delay >90 days were compared among volume quartiles and surgical approaches. ResultsThis study identified 23,494 patients who had undergone pancreatectomy for PDAC between 2010 and 2016 and met inclusion criteria. After correcting for confounders, compared to low volume hospitals patients at high-case-volume hospitals had the highest rates of AC administration after PD and DP. Moreover, compared to open surgery for all resection types, laparoscopic surgery was associated with a higher rate of AC use at high and highest-case-volume hospitals and less delay to chemotherapy at high-volume hospitals. For DP, laparoscopic approach had a positive impact on AC delay >90-day at the highest volume institutions only. ConclusionsLaparoscopic surgery for pancreatic cancer leads to higher utilization and lower probability of delay of AC in high and highest volume hospitals.

Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report

BackgroundThere is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail.Case presentationContrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery.ConclusionsIn patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function.

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.