Laparoscopic 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.

Laparoscopic resection of pancreatic masses in 12 dogs.

To describe the surgical management and outcome of dogs undergoing laparoscopic pancreatic mass resection (LPMR). Retrospective study. Twelve client-owned dogs. Data collected from medical records of dogs that underwent LPMR between 2012 and 2023 included signalment, clinical signs, mass location within pancreas, preoperative diagnostic imaging, laparoscopic approach, number of portals and device type used for LPMR, operating time, complications and clinical outcome. Pancreatic tumors were located in the left lobe (7), in the right lobe (4) and in the body of the pancreas (1). A 3- or 4-port technique was used in nine and three dogs, respectively. LPMR was performed with the Ligasure in nine dogs, a harmonic scalpel in two dogs and an endoscopic stapler in one dog. The procedure was performed successfully, with no conversion to open laparotomy, in all cases with a median operating time of 69 min. Postoperative complications occurred in four dogs, which resolved with medical treatments. All dogs survived the surgical procedure, were discharged from the hospital and alive a minimum of 90 days postoperatively. The final follow-up time ranged between 105 and 245 days (median 147). Histopathological diagnosis included insulinoma (9) and pancreatic carcinoma (3). LPMR was performed successfully using a 3- or 4-port technique and was associated with a low complication rate and a good clinical outcome. LPMR may be considered as an alternative to open celiotomy in dogs, particularly for small tumors located in the distal aspect of the pancreatic lobes.

Laparoscopic pancreatic enucleation: cystic lesions and proximity to the Wirsung duct increase postoperative pancreatic fistula.

Risk factors for postoperative pancreatic fistula (POPF) following pancreatic enucleation by the open approach (OpenEN) are well known. However, ENs are more frequently performed laparoscopically (LapEN). The aim of this study was to analyze the risk factors of POPF following LapEN. All patients in our prospective database who underwent LapEN were evaluated. We report the demographics, surgical, early and long-term outcomes. Numerous variables were analyzed to identify the risk factors of POPF. From 2008 to 2020, 650 laparoscopic pancreatic resections were performed including 64 EN (10%). The median age was 51years old (17-79), median BMI was 24 (19-48), and 44 patients were women (69%). The main presentation was an incidental diagnosis (n = 40; 62%), pain (n= 10;16%), and hypoglycemia (n = 8;12%). The main indications were neuroendocrine tumors (40; 63%), mucinous cystadenomas (15; 23%), intraductal papillary mucinous neoplasie (3; 5%), and other benign cysts (6; 9%). Lesions were located on the distal pancreas (43; 67%), head (n = 17; 27%), and neck (4; 6%). The median size was 20mm (9-110); 30mm (20-110) for mucinous cystadenoma and 18mm (8-33) for NET. The median operative time was 90mn (30-330), median blood loss was 20ml (0-800)ml, and there were no transfusions and one conversion. There were no mortalities and overall morbidity (n = 22; 34%) included grades B and C POPF (10;16%) and post-pancreatectomy hemorrhage (4; 6%). The median hospital stay was 7days (3-42). There were no invaded lymph nodes and all cystic lesions were nonmalignant. After a mean follow-up of 24months, there was no recurrence. The risk factors for grades B/C POPF were mucinous cystadenoma and proximity to the Wirsung duct < 3mm. In this series, the outcome of LapEN was excellent with no mortality and a low rate of morbidity. However, the risk of POPF is increased with cystic lesions and those close to the Wirsung duct.

Laparoscopic Surgery for Focal-Form Congenital Hyperinsulinism Located in Pancreatic Head.

Background and AimsCongenital hyperinsulinism of infancy (CHI) is a rare condition that may cause irreversible severe neurological damage in infants. For children in whom medical management fails, partial or near-total pancreatectomy is then required according to the type of lesion. Currently, open surgery of near-total pancreatic head resection is a mature technique for the treatment of focal-form CHI located in the head of the pancreas, but a minimally invasive laparoscopic procedure has not been reported yet. The aim of this study was to verify the feasibility, safety, and efficacy of laparoscopic pancreatic head resection and Roux-en-Y pancreaticojejunostomy for focal-form CHI.MethodsTwo infants with persistent hypoglycemia and increased insulin levels were diagnosed with CHI and underwent laparoscopic near-total pancreatic head resection due to a suboptimal response to medical therapy and the likelihood of focal disease amenable to surgery. Clinical records, operative findings, and postoperative follow-up were collected and analyzed.ResultsThe operative duration was 300–330 min, and the intraoperative blood loss was minimal. The duration of postoperative abdominal drainage was 4–5 days. Neither intra- nor postoperative abdominal complications occurred. Oral feeding was resumed 3–4 days after the operation, and the blood glucose level was gradually stabilized to within the normal range. Normal blood glucose was observed in both patients over a follow-up period of 3–6 months.ConclusionsLaparoscopic pancreatic head resection and Roux-en-Y pancreaticojejunostomy can be considered a safe and effective procedure with minimal morbidity and excellent outcomes for the treatment of focal CHI in the head of the pancreas.

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and does not compromise preservation of the distal pancreas

BackgroundThe diagnosis of low potential malignant diseases is increasingly frequent, and laparoscopic central pancreatectomy can be indicated in these patients. Laparoscopic central pancreatectomy that usually preserves the splenic vessels results in a low risk of new-onset diabetes but high morbidity, mainly due to postoperative pancreatic fistula and postpancreatectomy hemorrhage. In this study, we evaluated the short and long-term complications after laparoscopic central pancreatectomy with splenic vessel resection. MethodsThis retrospective single-center cohort study included 650 laparoscopic pancreatic resections from 2008 to 2020 with 84 laparoscopic central pancreatectomy; 15 laparoscopic central pancreatectomy with splenic vessel resection; and 69 laparoscopic central pancreatectomy with preservation of the splenic vessels. Pancreaticogastrostomy was routinely performed, and the patients were discharged after complications had been treated. The 15 laparoscopic central pancreatectomy with splenic vessel resection were matched for age, sex, body mass index, and tumor characteristics [1:2] and compared with 30 laparoscopic central pancreatectomy with the preservation of the splenic vessels. ResultsIn the laparoscopic central pancreatectomy with splenic vessel resection group, resection of splenic vessels was performed due to tumoral or inflammatory adhesions (n = 11) or accidental vascular injury (n = 4). The demographic characteristics of the groups were similar. Tumors were larger in the laparoscopic central pancreatectomy with splenic vessel resection group (40 vs 21 mm; P = .008), and right transection on the body of the pancreas (53% vs 13%; P = .01) was more frequent. There were no differences in the characteristics of the pancreas (Wirsung duct size or consistency). The median operative time (minutes) was longer in the laparoscopic central pancreatectomy with splenic vessel resection group than in the laparoscopic central pancreatectomy with preservation of the splenic vessels group (210 vs 180, respectively; P = .15) with more blood loss (100 mL vs 50 mL, respectively; P = .012). The lengths (mm) of the resected pancreas and remnant distal pancreas in the 2 groups were 65 vs 50 (P = .053) and 40 vs 65 (P = .006), respectively. There were no differences in postoperative mortality (0% vs 3%; P = .47), grade B–C postoperative pancreatic fistula (27% vs 27%; P = 1), reintervention (7% vs 13%; P = .50), grade B–C postpancreatectomy hemorrhage (0% vs 13%; P = .13), length of hospital stay (20 days vs 22 days; P = .15), or new-onset diabetes (7% vs 10%; P = .67) between the 2 groups. ConclusionLaparoscopic central pancreatectomy with splenic vessel resection is a safe technical modification of central pancreatectomy that does not prevent preservation of the distal pancreas and does not influence postoperative pancreatic fistula or endocrine insufficiency. Furthermore, it could reduce the risk of postpancreatectomy hemorrhage.

Conversion in Laparoscopic Pancreatic Resections: Risk Factors and Impact on the Outcome

Introduction: Laparoscopic pancreatic resection (LPR) is more frequently performed but conversion and its impact on the outcome were not frequently studied. This single series studied risk factors and impact of conversion. Methods: This is a retrospective study from a prospectively maintained databas. Main contraindications for LPR were major vascular invasion and pancreatitis. Demographics, surgical, and postoperative outcome were compared between patients without or with conversion. Results: From 2008 to December 2019, 658 LPR were performed including 173 PD (26%), 327 DP (50%), 88 CP (13%), 67 Enucleation (10%) and 3 TP (1%). The applicability of the laparoscopic approach increased from 10% before 2010 to 40% in 2019. Conversion was observed in 21 patients (3%) and was urgent in 7 patients (1%). No difference in demographics data but conversion was more frequent in older patients (55 vs 62, p=0.054) and with malignant ampulloma (4% vs 14%,p=0.029). Conversion was observed after PD (5%), after DP (3%) and after CP and enucleation (1%). Less conversion was observed after 2016 (4%vs 2%,p=0.046) with only one in the last 2 years. Conversion was associated with increased mean operative duration (202 vs 303,p<0.001), more blood loss (192 vs 823,p<0.001) ) and transfusion (2% vs 62%,p<0.001). The post-operative outcome showed increased pulmonary complications (6% vs 24%,p=0.001) and hospital stay (16 vs 23,p=0.005). Conclusion: Conversion is associated with increased morbidity and hospital stay. The very low rate of conversion in this series can be explained by good understanding of the surgical difficulty and improvement of the surgical technique.

700 Laparoscopic Pancreatic Resections in a French Center: Evolution of the Indications and Outcome

700 Laparoscopic Pancreatic Resections in a French Center: Evolution of the Indications and Outcome

Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy Is Safe and Does Not Compromise Preservation of the Distal Pancreas

Introduction: Laparoscopic central pancreatectomy (LCP) for non-malignant tumours, usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes and high morbidity represented mainly by postoperative pancreatic fistula (POPF) and post-pancreatectomy haemorrhage (PPH). In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications. Methods: This was a retrospective single center cohort study. Of 650 laparoscopic pancreatic resections from 2008 to 2020, 84 LCP with pancreatogastric anastomosis were performed. The 15 LCP-ResSV were matched [1:2] and compared with 30 LCP-PreSV according to age, sex, BMI and tumour characteristics. Results: In the LCP-ResSV, splenic vessels resection was performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). In the LCP-ResSV group, the tumour size was larger (40 vs 21 mm;p=0.008) and the right transection more frequently performed on the body (53%vs13%; p=0.01). The median operative time (min) was longer (210vs180; p=0.15) with more blood loss (100 mLvs 50 mL; p=0.012), respectively. The lengths (mm) of the resected pancreas and remnant distal pancreas were 65 vs 50 (p=0.053) and 40 vs 65 (p=0.006), respectively. There were no significant differences regarding postoperative mortality (0%vs3%), grade B-C POPF (27%vs27%), re-intervention (7%vs13%), grade B-C PPH (0%vs13%), hospital stay (20vs22 days) and new onset diabetes (7%vs10%). Conclusion: LCP-ResSV is a safe technical modification of CP that does not compromise preservation of the distal pancreas with no impact on POPF or endocrine insufficiency, compared to LCP-PresSV. Furthermore, it could reduce the risk of PPH.

PANCREATIC SOLID-PSEUDOPAPILLARY NEOPLASM IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS.

Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well. The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare. We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female). ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas. Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible.

Simultaneous transoral parathyroidectomy and laparoscopic pancreatic resection in type 1 Multiple Endocrine Neoplasia syndrome

The article presents a clinical observation of a patient with type 1 Multiple Endocrine Neoplasia syndrome (MEN 1). During the diagnostic search, a combination of primary hyperparathyroidism, parathyroid adenoma and hormonally inactive pancreatic head tumor was found. Simultaneous transoral parathyroidectomy and laparoscopic resection of the pancreatic head was performed. We haven`t found the literature data describing such kind of operations for MEN 1 syndrome. An original solution was applied to perform intraoperative ultrasonography monitoring. The results of 1-year postoperative follow-up are presented. This observation demonstrates the possibilities of endoscopic technologies in the treatment of MEN 1 syndrome.

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.

Multifocal pancreatic PPoma in the setting of MEN1: Case report and review of literature.

Introduction and importanceFunctioning pancreatic neuroendocrine tumors (pNETs) that express pancreatic polypeptide—PPomas—do not yet have a pathognomonic clinical syndrome associated with them due to their overall rarity and diverse symptoms. Moreover, in patients with MEN1, the often multifocal nature of pNETs presents a unique clinical issue.Case presentationWe report a case of a 22-year-old man with a known MEN1 gene mutation who was suffering from severe diarrhea (7–8 bowel movements per day) and was found to have only elevated PP levels on biochemical work-up. Ga68-DOTATATE PET/CT showed multifocal tumors in the body and tail of the pancreas that were not evident on contrast-enhanced CT. The patient underwent a successful laparoscopic radical antegrade modular pancreatosplenectomy (RAMP) and recovered well post-operatively with complete resolution of his diarrhea. Immunohistochemistry showed multiple pure PPomas.Clinical discussionThis case highlights the unique propensity for multifocal disease in patients with MEN1 mutations and the utility of functional imaging by somatostatin analogs, i.e., Ga68-DOTATATE PET/CT, in order to perform oncologic laparoscopic pancreatic resections.ConclusionPPomas in the setting of MEN1 mutations are a unique clinical entity due to their diverse associated clinical syndromes and propensity for multifocal disease.

Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

BackgroundPancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).MethodsWe assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared.ResultsCompared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). These two groups did not show a significant difference in the pattern of recurrence and overall survival rate.ConclusionsLaparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.

Laparoscopic pancreatic surgery: single center experience

Introduction: Laparoscopic pancreatic resections are widely performed. We analyzed short-term operative outcomes of laparoscopic pancreatic surgery, compared to open surgery. Method: We retrospectively reviewed data of 150 patients who underwent distal pancreatectomy (DP) at Chonnam National University Hospital from 2009 to 2019 and 93 patients who underwent pancreaticoduodenectomy (PD) from 2014 to 2019. We reviewed each patient's age, sex, pathologic diagnosis, hospital stay, operative time, estimated blood loss, morbidity, 30-day mortality, incidence of postoperative pancreatic fistula (POPF), and post-pancreatectomy hemorrhage (PPH). Results: 81 patients underwent open distal pancreatectomy (ODP) and 69 patients underwent laparoscopic distal pancreatectomy (LDP). Intraoperative estimated blood loss was significantly lower in the LDP group than ODP group (200 vs. 400ml p< 0.01).There was no significant difference in incidence of POPF (p=0.235), morbidity (18 vs. 30 p=0.152 ), PPH, wound infection, hospital stay and readmission. Delayed gastric emptying in LDP group occurred less than in the ODP group. 50 open PD (OPD) and 30 laparoscopic PD (LPD) were performed by single surgeon. Median operation time was 422 minutes (range. 210-695) in OPD and 527 minutes (range, 425-910) in LPD. Blood loss of OPD and LPD was 500ml (range, 200-2300) and 300ml (range, 100-3000), respectively. Median hospital stay was shorter in LPD group (15.5 vs 19 days). Conclusions: LDP showed more shorten hospital stay and less blood loss than open surgery. Operation time is longer in LPD group than OPD group. However, Hospital stay was shorter in LPD group. In conclusion, Laparoscopic pancreatic surgery is feasible and safe.

Tailored laparoscopic approach for pancreatic tail resection for cancer

Laparoscopic resection is becoming the gold standard for distally located lesions of the pancreas. Changing the standard technique from the medial-to-lateral to lateral-to-medial approach can simplify the procedure in case of previous surgery, a known risk factor for conversion. We report the case of laparoscopic pancreatic tail resection with spleen preservation in a 79 y.o. woman affected by an 18 mm hypervascular lesion (Fig.1); the patient underwent to a left nephrectomy, trough a median laparotomy, thirty-three years before, for a clear cell renal carcinoma. The SUV at Ga68-DOTATOC-PET-CT was 14.9 and at F18-FDG-PET-CT was null. Operative technique: four trocar were positioned in L shape manner in the upper left quadrant of the abdomen, with patient in 30° right lateral position. We started lowering the colonic splenic flexure, exposing the tail of the pancreas and the tumor. The lesser sac was opened below the left gastroepiploic vessels. The body-tail were freed from retroperitoneal tissue, in a lateral-to-medial way. Finally, small arterial and venous branches of the splenic vessels were cut between clips. For parenchymal transection we used a 60 mm linear stapler, vascular cartridge; a suture of the stump was required to complete the hemostasis. The specimen was extracted by an endobag through the supraumbilical incision, and a drain was left close to the stump. After an uneventful postoperative course, the patient was discharged in the fourth postoperative day. The pathological report described a metastasis from clear cell renal carcinoma.

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and reduces the risk of post-operative haemorrhage

Purpose: Low potential malignant diseases are more frequently discovered and laparoscopic central pancreatectomy (LCP) can be indicated. LCP usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes at the expense of a high morbidity represented mainly by post-operative pancreatic fistula (POPF) and bleeding. In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long term complications. Methods: Of 650 laparoscopic pancreatic resections from 2011 to 2020, 84 LCP were performed, including 15 LCP-ResSV and 69 LCP-PreSV. The 15 CPL-ResSV were matched [1:2] with 30 CPL-PreSV according to age, sex, BMI and tumor characteristics (neuroendocrine tumor, mucinous cystadenoma, intraductal papillary mucinous neoplasm, solid pseudopapillary neoplasm, cyst, others). Pancreatogastric anastomosis was achieved in all patients and patients were discharged after healing of complications. Both groups (LCP-ResSV vs LCP-PreSV) were compared. Results: In the LCP-ResSV, splenic vessels resection were performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). There was no difference regarding demographics data. The tumour size was larger in LCP-ResSV (40mm vs 21mm; p = 0.008) and the right transection was more frequently done on the body (53% vs 13%; p=0.01). There was no difference in pancreatic characteristics (Wirsung duct size and consistency). The median operative time was longer in LCP-ResSV group (210 min vs 180 min ; p=0.15) with more blood loss (100 mL vs 50 mL ; p=0.012). The lengths (mm) of the resected pancreas and remnant distal pancreas were 65mm vs 50mm (p=0.053) and 40mm vs 65mm (p=0.006), respectively. There were no differences regarding post-operative mortality (0% vs 3% ; p = 0.47), grade B-C POPF (27% vs 27% ; p = 1), re-intervention (7% vs 13% ; p = 0.50); grade B-C bleeding (0% vs 13%; p = 0.13), length of hospital stay (20 days vs 22 days; p = 0.15) and new onset diabetes (7% vs 10%; p = 0.67). Conclusion: LCP-ResSV is a safe technical modification of central pancreatectomy with no impact on pancreatic fistula risk or endocrine insufficiency, compared to LCP-PreSV. Furthermore, it could reduce the risk of post-operative haemorrhage.

Laparoscopic resections of the pancreas in children with hyperinsulinism

Introduction. Congenital hyperinsulinism (CHI) is an inherited disease characterized by severe persistent hypoglycemia in the neonatal period due to insulin hypersecretion and rapid development of neurologic and systemic disorders. There are two main CHI forms: a diffuse one when hyper functioning of beta-cells affect the whole pancreas, and a focal one, characterized by an area of intact parenchyma. Currently, surgery is an acknowledged approach in focal forms, while in diffuse CHI forms surgical treatment is prescribed only in severe pharmacoresistant cases.Material and methods. A total of 11 patents with CHI, aged 1.5 - 26 months, had laparoscopic pancreatic resections at the department of pediatric surgery of Russian Medical Academy of Continuous Professional Education. All patients were examined , treated and prepared for surgery at the Endocrinology Research Centre ( Moscow). The focal CHI form was diagnosed in 3 children; the diffuse one - in 8 patients. In the focal CHI form, a focal resection was done: laparoscopic corpocaudal resection of the pancreas – 2 patients; resection of the pancreatic head with Roux–en-Y pancreaticojejunostomosis - 1 child. All children with diffused disease had laparoscopic near-total (98%) pancreatectomy.Results. In all cases, there were no intraoperative complications. Stenosis of the distal common bile duct developed in one child after the resection of pancreatic head which required a laparoscopic cholecystoduodenoanastomosis. There were no other complications. Two children with focal CHI were reported to recover completely; one patient suffered of hypoglycemia attacks not related to the increased insulin production. In diffuse cases, a stable euglycemia was achieved in 2 patients; 3 children had recurrent hypoglycemia attacks which required Somatostatin analogue therapy. One patient developed diabetes mellitus. In this case, follow-up period lasted for 2 months which is too short to assess the endocrinological outcome.Conclusion. The article presents the first Russian experience of laparoscopic pancreas resection in children with CHI. The laparoscopic approachcan be successfully applied in the surgical treatment of children with CHI.

WITHDRAWN: Research and application of laparoscopic precision pancreatic cancer surgery based on three-dimensional reconstruction

Abstract Objective To evaluate the clinical value of image studies using three-dimensional reconstruction techniques in preparation for laparoscopic pancreatic tumor resections. Methods We retrospectively collected the clinical data of patients with pancreatic tumors from January 2017 to November 2018. A total of 204 patients were randomly divided into a study group or control group. The patients in study group performed preoperative three-dimensional reconstruction and patients in control group did not. The operation time, intraoperative blood loss, number of lymph nodes retrieved, and R0 resection rate were recorded. Results In patients undergoing laparoscopic pancreaticoduodenectomy, patients in study group had higher R0 resection rate (96.72% vs. 83.93%, p = 0.031), larger number of dissected lymph nodes (10.71 ± 7.20 vs. 4.98 ± 2.56, p = 0.010), shorter operation time (273.4 ± 91.3 min vs. 371.7 ± 102.4 min, p Conclusion Preoperative three-dimensional reconstruction is helpful for tumor localization in laparoscopic pancreatic tumor resection. This preoperative method can shorten the operation time, reduce intraoperative bleeding, and improve the cure rate of pancreatic tumors during laparoscopic pancreaticoduodenectomy.

Laparoscopic central pancreatectomy: Results in 81 patients

Presenter: Safi Dokmak | Beaujon Hospital Background: Low potential malignant diseases are more frequently discovered and when surgery is indicated, parenchymal sparing resection is recommended to avoid long term endocrine and exocrine insufficiency. For centrally located lesions, central pancreatectomy (CP) can be indicated; however this one is not frequently performed related to higher morbidity compared to distal pancreatectomy. When CP is indicated, the laparoscopic approach is a good indication as the technical applicability rate is very high related to the absence of oncological or vascular contraindication. The aim of this study was to analyze our monocentric experience. Methods: Between 2008-2018, 540 laparoscopic pancreatic resections were performed in our department and 81 patients underwent laparoscopic CP. CP was indicated if enucleation was not feasible, in non-diabetic patients and if the distal pancreas was > 5 cm. The laparoscopic approach compared to the open approach was applied according to the surgeon experience and was nearly 100% with laparoscopic surgeons. The pancreas was divided on the neck by stapler when possible, the distal pancreas was mobilized and sectioned 1 cm to the left of the tumor with frozen section when indicated. One layer Pancreato-gastric anastomosis was fashioned and the nasogastric tube was left for 5 days with parenteral nutrition. All patients with pancreatic fistula were managed in the hospital until complete healing. All clinical, operative and postoperative data were recorded prospectively and were analyzed. Results: The mean age was 50 (17-77), including 55 female (68%), with a mean BMI at 25 (16-36) and 17 (21%) were obese. Indications for resection were for neuroendocrine tumor (24; 30%), IPMN (16; 20%), solid pseudopapillary tumor (12; 15%), mucinous cystadenoma (11; 14%), pancreatitis with disconnected duct syndrome (5; 6%), adenocarcinoma (3; 4%) and other (10; 11%). In patients with adenocarcinoma, the diagnosis was made postoperatively and completion distal pancreatectomy was done few weeks later. The mean operative time was 183 (90-285), the mean blood loss 107 (0-800), one transfusion (1%), and one conversion (1%) in the early experience. The pancreas was hard in 37 patients (46%). No 90 days mortality and the overall morbidity was observed in 58 patients (72%) including grade B/C pancreatic fistula (21; 26%), bleeding (10; 12%) which was severe in 5 (6%), drained collection (2; 3%), delayed gastric emptying (2; 3%), re-intervention (5; 6%), and pulmonary complications (3; 4%). the mean hospital stay was 22 days (5-54) with readmission in 2 (2%). The mean number of harvested lymph nodes was 3 (0-19) including 18 (22%) patients with zero harvested lymph nodes. Lymph nodes were only invaded in patients who turned to have adenocarcinoma. Resection was R0 in 71 (88%) patients. Conclusion: The applicability of laparoscopic central pancreatectomy is high and the morbidity is acceptable. There is a real advantage on the preservation of the pancreatic function and abdominal wall in these young patients with no malignancy.

Stepwise implementation of laparoscopic pancreatic surgery. Case series of a single centre's experience.

Laparoscopic pancreatic surgery still represents a challenge for surgeons. However, in recent decades the experience is expanding. Recent systematic reviews and meta-analyses confirm that laparoscopic pancreatic resection (LPR) is safe, feasible and worthwhile. This study analyses the first 100 consecutive LPRs in our centre. A retrospective analysis was conducted of the first 100 LPRs in a single supra-regional Belgian centre, performed between January 2012 and January 2019. Pre-, peri- and postoperative data were retrieved from a prospectively maintained database. All procedures were performed laparoscopically by two attending surgeons, specialized in minimally invasive and hepatopancreatobiliary surgery. Of 100 procedures, 62 laparoscopic pancreatoduodenectomies (LPD) and 36 laparoscopic distal pancreatectomies (LDP) were performed, along with 1 enucleation and 1 central pancreatectomy. Indication was malignancy in 70%. Conversion rate was 24,2% in LPD and 11% in LDP. Median operative time was 330 min (IQR 300-360) in LPD and 150 min (IQR 142.5-210) in LDP. Median blood loss was 200 mL (IQR 100-487.5) in LPD and 150 mL (IQR 50-500) in LDP, transfusion rate was 22.6% and 8.3% respectively. Median length of stay (LOS) was 13 days (IQR 10-19.25) in LPD and 9 days (IQR 9-14) in LDP. R0 resection rate was 88.6% (62/70). Major complication rate (Clavien-Dindo grade III-IV) was 12%. Thirty-day mortality was 0%, 90-day mortality was 2%. Our results confirm that LPR is a feasible and safe alternative to open pancreatic surgery. Safe implementation with a clear strategy is fundamental to gain experience and overcome the learning curve of this technically demanding procedures.