Laparoscopic Pancreatic Surgery Research Articles

Application of Simplified Duct-to-Mucosa Pancreaticojejunostomy for Nondilated Pancreatic Duct in Laparoscopic Pancreatic Surgery.

The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic surgery. The data of 19 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and 2 patients who underwent laparoscopic central pancreatectomy were retrospectively analyzed. All patients underwent pure laparoscopic surgery successfully with simplified duct-to-mucosa pancreaticojejunostomy. The operation time of LPD was 365.11±41.56 minutes, the time of pancreaticojejunostomy was 28.39±12.58 minutes, and postoperative hospitalization time was 14.16±6.88 days on average. Postoperative complications occurred in 3 patients of LPD, including 2 cases of class B postoperative pancreatic fistula and 1 case of gastroparesis followed by gastrointestinal anastomotic perforation. The operative time of laparoscopic central pancreatectomy was 191.00±12.73 minutes, the time of pancreaticojejunostomy 36.00±5.66 minutes, and the postoperative hospitalization time 12.5±0.71 days on average. The described technique is a simple and safe reconstruction procedure and suitable for patients with nondilated pancreatic duct.

Major Venous Repair or Reconstruction During Laparoscopic Pancreatic Surgery: A Single Center's Experience.

Background: In pancreatic cancer surgery, tumor violation of blood vessels is often considered a contraindication to surgery, especially laparoscopic surgery. We have completed 17 cases of major venous repair or reconstruction during laparoscopic pancreatic surgery, and we believe that this surgical method may be safe and feasible based on the skilled laparoscopic techniques. Materials and Methods: Between January 2014 and March 2022, a prospective cohort of 17 patients underwent major venous repair or reconstruction in our department. Among them, 15 cases underwent laparoscopic pancreaticoduodenectomy, 1 case underwent laparoscopic distal pancreatectomy, and 1 case underwent laparoscopic central pancreatectomy. In all of these cases, the pancreatic tumor invaded either portal veins (PV) or superior mesenteric veins. Given these clinical situations, 13 cases accepted laparoscopic venous resection and reconstruction, and 4 cases underwent venous repair. Results: Ten of 17 patients (58.8%) were male. The mean age was 67.1 (range 57-81). All patients' operations were successfully completed without transit to open. The average blocking time of venous resection and reconstruction was 30.1 (range 15-41) minutes and the average time of venous wedge resection and stitching was 24.0 (range 18-30) minutes. After surgeries, there were no complications such as PV stenosis, bleeding, thrombosis, and liver failure. Thirteen patients died within 2 years because of the tumor recurrence, and 4 patients are currently followed by outpatient visits, with no obvious signs of tumor recurrence. Conclusion: Studies have shown that the reconstruction or repair of the major veins under laparoscopic surgery is safe and effective. We recommended that surgeons need to have the basics of open surgery in case laparoscopic surgery cannot be continued, and have proficient laparoscopic surgery techniques combined with extensive training to achieve a learning curve for vascular anastomosis. Clinical Trial Registration number: KY2021SL152-01.

Application of a sectional U-shaped reinforcement combined with penetrating pancreaticojejunostomy (U-PPJ) for soft pancreas in laparoscopic pancreatic surgery.

Laparoscopic techniques have been widely used in pancreatic surgery, such as laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic central pancreatectomy (LCP). Laparoscopic pancreaticojejunostomy (LPJ) is a common procedure for LPD and LCP, and is also the most critical. The quality of LPJ is associated with the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). Although LPJ technology has been greatly improved, CR-POPF cannot be completely avoided especially to soft pancreas, which is an important reason for the high risk of laparoscopic pancreatic surgery. To date, there is a lack of standard LPJ approaches. Here, we report a U-shaped suture reinforcement for soft pancreatic section combined with penetrating pancreaticojejunostomy (PPJ) technique, called U-PPJ. Twenty-three patients with soft pancreas who underwent laparoscopic pancreatic surgery adopting U-PPJ method between 2017 and 2022 were enrolled (LPD = 19, LCP = 4). Preoperative, intraoperative and postoperative indexes were collected and analyzed. The results showed that all patients treated with U-PPJ were discharged without drainage tube or a small amount of exudate in the drainage tube does not require clinical treatment, but only needs to be removed after 2 days of observation. The average operation time was 417.35min. The intraoperative blood loss was 171.74ml. The pancreatic duct diameter was 3.41mm. The average postoperative hospitalization days were 11.83days. The average postoperative drainage tube removal time was 13.26days. The incidence of postoperative B-grade pancreatic fistula was 4.3%, and no C-grade pancreatic fistula occurred. In our experience, U-PPJ can be completed by a skilled surgeon in less than 20min. U-PPJ is safe, reliable, convenient and has a low incidence of CR-POPF in soft pancreas, which is worthy of clinical application. It also provides more options for laparoscopic pancreatic surgery. Since this is a retrospective study with a small number of cases, more prospective multicenter studies are needed to further verify its safety and efficacy.

Risk factors for lymph node metastasis in patients with pancreatic neuroendocrine neoplasms.

BACKGROUNDAlthough PNENs generally have a better prognosis than pancreatic cancers, some PNENs display malignant behavior including lymph node (LN) metastasis. Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs. However, the indications for LN dissection are still controversial. Over the last decade, minimally invasive surgery such as laparoscopic pancreatic surgery (LPS) has been increasingly performed for pancreatic tumors including PNENs.AIMTo investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.METHODSFrom April 2001 to December 2019, 92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital. Finally, 82 patients were enrolled in this study. Using perioperative factors, we examined the predictive factors for LN metastasis in PNENs.RESULTSAmong the 82 patients, the percentage of LN metastasis according to the pathological findings was 12% (10/82 cases). The median tumor size was 12 mm (range: 5-90 mm). The median tumor size in the LN-positive group (37 mm) was significantly larger than that in the LN-negative group (12 mm) (P = 0.0001). Multivariate analyses revealed that larger tumor size (≥ 20 mm) was an independent risk factor for LN metastasis (odds ratio 16.8, P = 0.0062). In patients with small tumors (≤ 10 mm), LN metastasis was not found.CONCLUSIONLarger tumor size (≥ 20 mm) is an independent risk factor for LN metastasis in PNENs. In smaller PNENs (≤ 10 mm), we may be able to choose limited surgery without LN dissection.

Intraoperative navigation system with a multi-modality fusion of 3D virtual model and laparoscopic real-time images in laparoscopic pancreatic surgery: a preclinical study

BackgroundLaparoscopy is widely used in pancreatic surgeries nowadays. The efficient and correct judgment of the location of the anatomical structures is crucial for a safe laparoscopic pancreatic surgery. The technologies of 3-dimensional(3D) virtual model and image fusion are widely used for preoperative planning and intraoperative navigation in the medical field, but not in laparoscopic pancreatic surgery up to now. We aimed to develop an intraoperative navigation system with an accurate multi-modality fusion of 3D virtual model and laparoscopic real-time images for laparoscopic pancreatic surgery.MethodsThe software for the navigation system was developed ad hoc. The preclinical study included tests with the laparoscopic simulator and pilot cases. The 3D virtual models were built using preoperative Computed Tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data. Manual and automatic real-time image fusions were tested. The practicality of the navigation system was evaluated by the operators using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) method.ResultsThe 3D virtual models were successfully built using the navigation system. The 3D model was correctly fused with the real-time laparoscopic images both manually and automatically optical orientation in the preclinical tests. The statistical comparative tests showed no statistically significant differences between the scores of the rigid model and those of the phantom model(P > 0.05). There was statistically significant difference between the total scores of automatic fusion function and those of manual fusion function (P = 0.026). In pilot cases, the 3D model was correctly fused with the real-time laparoscopic images manually. The Intraoperative navigation system was easy to use. The automatic fusion function brought more convenience to the user.ConclusionsThe intraoperative navigation system applied in laparoscopic pancreatic surgery clearly and correctly showed the covered anatomical structures. It has the potentiality of helping achieve a more safe and efficient laparoscopic pancreatic surgery.

Outcomes of Surgical Resection of Pancreatic Cystic Neoplasms Based on the European Expert Consensus Statement: A Prospective Observational Study

Background: The most common types of true epithelial exocrine pancreatic cystic neoplasms are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), intra-ductal papillary mucinous neoplasms (IPMNs), and solid pseudo-papillary neoplasms (SPPNs). Both open and laparoscopic pancreatic surgeries are major procedures with significant morbidity and mortality rates. This study aimed to determine the outcomes of laparoscopic pancreatic surgery in managing true exocrine epithelial pancreatic cystic neoplasms in terms of postoperative pancreatic fistula and recurrence rate and to identify associated risk factors.

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.

Current Status of Laparoscopic and Robotic Pancreatic Surgery and Its Adoption in Singapore

Despite the potential clinical advantages offered by laparoscopic pancreatic surgery (LPS), the main obstacle to its widespread adoption is the technically demanding nature of the procedure and its steep learning curve. LPS and robotic pancreatic surgery (RPS) have been proven to result in superior short-term perioperative outcomes and equivalent long-term oncological outcomes compared to the conventional open approach, with the caveat that they are performed by expert surgeons who have been trained to perform such procedures. The primary challenge faced by most pancreatic surgeons is the steep learning curve associated with these complex procedures and the need to undergo surgical training, especially with regards to laparoscopic and robotic pancreaticoduodenectomy. Current evidence suggests that RPS may help to shorten the lengthy learning curve required for LPS. More robust evidence-in the form of large randomised controlled trials-is needed to determine whether LPS and RPS can be safely adopted universally.

Perioperative Nursing Methods and Nursing Effects of Laparoscopic Pancreatic Surgery

Perioperative Nursing Methods and Nursing Effects of Laparoscopic Pancreatic Surgery

Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis.

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The recent rise of robotic and laparoscopic pancreatic surgery has found benefits such as reduced time to functional recovery. Few studies have reported on the feasibility, technique and outcome of robotic LPJ, especially including transection of the gastroduodenal artery. The present study describes the main steps for robotic LPJ in a patient with painful chronic pancreatitis with a dilated main pancreatic duct. The patient underwent robotic LPJ. The LPJ anastomosis is performed using a running suture technique in a longitudinal side-to-side manner. Routinely, the gastroduodenal artery is transected to drain the entire length of the main pancreatic duct. The patient is in French position; 7 trocars are placed (4 robotic, 2 laparoscopic assistants, 1 liver-retractor). After docking of the robot system, the omental bursa is opened, and the right gastroepiploic artery and vein are ligated at their base at the lower border of the pancreas. Intraoperative ultrasonography is performed in order to determine trajectory of the dilated main pancreatic duct which is opened for its entire length after the gastroduodenal artery has been suture ligated both cranially and caudally from the main pancreatic duct. A Roux limb is created, and a latero-lateral PJ is fashioned using several 3-0 barbed sutures. A stapled jejuno-jejunostomy is created at sufficient distance from the pancreatic anastomosis, aided by a 50 cm suture. The described technique for robotic LPJ is a complex but feasible operation for patients with treatment refractory CP and a dilated main pancreatic duct. Due to its complexity, implementation in high volume centers with extensive experience with CP surgery may improve outcomes.

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.

Laparoscopic pancreaticoduodenectomy for remnant pancreatic recurrence after laparoscopic distal pancreatectomy and hepatectomy for greater omentum leiomyosarcoma

Laparoscopic pancreatic surgery is one of the most difficult procedures, and the adoption of laparoscopic pancreaticoduodenectomy has been limited. The application of laparoscopic surgery has extended to advance cancer, but there have been no reports of laparoscopic pancreaticoduodenectomy after laparoscopic liver resection and distal pancreatectomy. In the present case, a 67-year-old woman was diagnosed with remnant pancreatic recurrence of metastatic greater omentum leiomyosarcoma. She had previously undergone laparoscopic distal pancreatectomy and left lateral liver sectionectomy in 2016. We performed laparoscopic subtotal stomach-preserving pancreaticoduodenectomy in June 2017. The operation time was 274 minutes, and the estimated blood loss was 50 mL. There were no postoperative complications. In summary, laparoscopic pancreaticoduodenectomy is a safe and feasible procedure for a patient who had previously undergone pancreas and liver surgery.

Outcomes of a Multicenter Training Program in Laparoscopic Pancreatoduodenectomy (LAELAPS-2).

The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD). Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. Multicenter, structured LPD training programs reporting outcomes including the first procedures are lacking. No LPD had been performed in the Netherlands before this study. During 2014-2016, 8 surgeons from 4 high-volume centers completed the Longitudinal Assessment and Realization of Laparoscopic Pancreatic Surgery (LAELAPS-2) training program in LPD, including detailed technique description, video training, and proctoring. In all centers, LPD was performed by 2 surgeons with extensive experience in pancreatic and laparoscopic surgery. Outcomes of all LPDs were prospectively collected. In total, 114 patients underwent LPD. Median pancreatic duct diameter was 3 mm [interquartile range (IQR = 2-4)] and pancreatic texture was soft in 74% of patients. The conversion rate was 11% (n = 12), median blood loss 350 mL (IQR = 200-700), and operative time 375 minutes (IQR = 320-431). Grade B/C postoperative pancreatic fistula occurred in 34% of patients, requiring catheter drainage in 22% and re-operation in 2%. A Clavien-Dindo grade ≥ III complication occurred in 43% of patients. Median length of hospital stay was 15 days (IQR = 9-25). Overall, 30-day and 90-day mortality were both 3.5%. Outcomes were similar for the first and second part of procedures. This LPD training program was feasible and ensured acceptable outcomes during the learning curve in all centers. Future studies should determine whether such a training program is applicable in other settings and assess the added value of LPD.

The superior approach with stomach roll-up technique has a stimulating effect on learning of laparoscopic distal pancreatectomy for training surgeons

Introduction: We introduced the superior approach and a unique technique to retract the stomach called the “stomach roll-up technique” to simplify and standardize laparoscopic distal pancreatectomy, and to facilitate the learning of laparoscopic pancreatic surgery for training surgeons. The aim of this study was to evaluate the clinical outcomes of our novel procedures. Method: Forty-five patients who underwent laparoscopic distal pancreatectomy by training surgeons between January 2015 and December 2018 were included. In this period, 20 laparoscopic distal pancreatectomies were performed using the inferior approach, and then 25 procedures were performed using the superior approach. The clinicopathological findings and perioperative outcomes were retrospectively analyzed. Result: Compared with the inferior approach, the superior approach was associated with significantly shorter operation time (p < 0.001) and less estimated blood loss (p = 0.011). There were no significant differences in postoperative outcomes between the groups. In multifactorial analysis, the superior approach was the only factor that had significantly positive effect on decreasing operation time (p = 0.002). Conclusion: Laparoscopic distal pancreatectomy using the superior approach with the stomach roll-up technique performed by training surgeons was associated with better intraoperative outcomes than those of the inferior approach. These techniques are simple and will aid pancreatic surgeons in performing laparoscopic distal pancreatectomy.

True learning curve of laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation

Laparoscopic distal pancreatectomy (LDP) is generally the treatment of choice for diseases of the pancreatic body and tail. Most surgeons prefer the spleen- and splenic vessel-preserving technique (SPVP-LDP) in benign/borderline pancreatic disease because complications of splenic infarction and gastric varices can arise after Warshaw technique. This study was aimed to determine the true learning curve of the SPVP-LDP procedure not LDP including Warshaw technique. Data were collected retrospectively from all patients who underwent a LDP between June 2007 and April 2017 at Gangnam Severance Hospital. We used cumulative sum control chart (CUSUM) analysis to assess the learning curve for the SPVP-LDP technique. Eight-three patients were performed LDP and we excluded patients who underwent robotic approach (N = 10) and open conversion DP (N = 8). Patients who underwent SPVP-LDP procedures were categorized into Group 1 (primary end-point). Those who underwent LDP procedures with splenectomy and the Warshaw technique were categorized into Group 2. We found that the 16th case was the cutoff point and the mean length of hospital stay was 13.0 days in the first period and 8.7 days in the second period (p = < 0.001). These results indicated that the frequency of SPVP-LDPs had increased and that technological progress had been made over time. The true learning curve for SPVP-LDP was indicated as 16 cases in a group of surgeons with no experience of laparoscopic pancreatic surgery.

Trends in Robotic Pancreaticoduodenectomy and Distal Pancreatectomy.

Pancreatic surgery remains a challenge even to the most experienced surgeons. Despite significant advances in the field, morbidity and mortality continue to have elevated rates even in specialized, high-volume centers. The rise of laparoscopy in the past decades has improved outcomes for patients, but remains unused due to the technical complexities involved. A literature search was performed using PubMed and Google Scholar databases. Key words used in the search include: "robotic surgery," "robotic pancreas surgery," "pancreas surgery," "minimally invasive pancreas surgery," "robotic pancreaticoduodenectomy," and "robotic distal pancreatectomy." The studies included in our review were summarized in a patient intervention comparison and outcome table. The use of a robotic platform has emerged to counteract the more challenging aspects of laparoscopic pancreatic surgery, but incurs a high cost. Data, however, show a trend toward ever improving outcomes such as operative time, estimated blood loss, and length of stay, while still offering the benefits of minimally invasive surgery. There is no question that the use of robots in surgery will continue to expand, and with this, appropriate measures must be taken to ensure patient safety in the form of standardized education and certification for the future generation of surgeons considering robotic surgery. As robotic pancreatic surgery grows, encouraging data have emerged-as surgeons become more skilled and programs gain experience, patients are being benefited by this expanding technology. Larger, prospective cohorts will also provide more definitive evidence of the benefits of robotic surgery.

Is laparoscopic pancreatic enucleation appropriate for all pancreatic diseases?

Introduction: With the widespread of laparoscopic pancreatic surgery, enucleation is considered as an excellent indication to the laparoscopic approach. Our aim was to analyze our indications and results. Methods: From January 2008 to September 2017, among the 422 patients who underwent laparoscopic pancreatic resection, 41(10%) underwent laparoscopic enucleations and were studied retrospectively. Results: The mean age was 50 (17-74), mean BMI 25 (19-36) and 29 were females (71%). Main indications were neuroendocrine tumor (26; 63%); Mucinous cystadenoma (7; 17%), other benign cysts (7; 17%) and only one intra-ductal papillary mucinous neoplasia (IPMN) (3%). Lesions were located in the head (n=14; 34%).The mean size was 24 mm (9-80). The mean operative time was 110 mn (30-330), the mean blood loss was 64 ml (0-800) ml and no transfusion and one conversion. No 90 days mortality. Overall morbidity in 14 patients (34%), represented by pancreatic fistula of grades B and C (5;12%), bleeding (2;5%), one drained collection and no -intervention. Lymph nodes was harvested in 14 patients (34%) with a mean number 0.7(0-5) and negative in all. The mean hospital stay was 11 days (4–42). Conclusion: The excellent outcome of laparoscopic enucleation is explained by the low rate of enucleation for IPMN, which are theoretically at higher risk of complications. IPMN of good indications to the laparoscopic approach (peripheral branch ducts) do not necessary need surgery, and those who need surgery (small revealed by pancreatitis) are not good indications for the laparoscopic approach related to inflammation and difficult location (deep and small).

True learning curve of laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation.

Laparoscopic distal pancreatectomy (LDP) is generally the treatment of choice for diseases of the pancreatic body and tail. Most surgeons prefer the spleen- and splenic vessel-preserving technique (SPVP-LDP) in benign/borderline pancreatic disease because complications of splenic infarction and gastric varices can arise after Warshaw technique. This study was aimed to determine the true learning curve of the SPVP-LDP procedure not LDP including Warshaw technique. Data were collected retrospectively from all patients who underwent a LDP between June 2007 and April 2017at Gangnam Severance Hospital. We used cumulative sum control chart (CUSUM) analysis to assess the learning curve for the SPVP-LDP technique. Eight-three patients were performed LDP and we excluded patients who underwent robotic approach (N = 10) and open conversion DP (N = 8). Patients who underwent SPVP-LDP procedures were categorized into Group 1 (primary end-point). Those who underwent LDP procedures with splenectomy and the Warshaw technique were categorized into Group 2. We found that the 16th case was the cutoff point and the mean length of hospital stay was 13.0 days in the first period and 8.7 days in the second period (p = < 0.001). These results indicated that the frequency of SPVP-LDPs had increased and that technological progress had been made over time. The true learning curve for SPVP-LDP was indicated as 16 cases in a group of surgeons with no experience of laparoscopic pancreatic surgery.

Near-infrared intraoperative imaging of pancreatic neuroendocrine tumors: a new era in laparoscopic pancreatic surgery

It is evident that safe complete resection of the target tumor without excess or deficiency is the most important object in the oncological surgery, besides this is particularly true in the laparoscopic surgery for pancreatic neuroendocrine tumors (PanNETs).

Laparoscopic Surgery for Liver and Pancreatic Neoplasms

Aim . To analyze early outcomes of laparoscopic surgery and to show their advisability in surgical treatment of liver and pancreatic neoplasms. Material and Methods. There were 60 patients with liver tumors and 44 patients with pancreatic neoplasms who underwent laparoscopic surgery. Prospective control groups consisted of patients after conventional procedures. Results. Overall incidence of postoperative complications was 8.3% after laparoscopic liver interventions that was significantly less than in open procedures. Incidence of post-resection liver failure and biliary complications (ISGLS, 2011) was similar after laparoscopic and open liver interventions. Overall complication rate after laparoscopic pancreatic surgery was 6.8% that was significantly lower compared with standard interventions. Incidence of postoperative fistula (ISGPF, 2005) was 4.5% (Grade A – 2.3%, Grade B – 2.3%), that was significantly less than in open surgery 29.5% (Grade A – 15.9%, Grade B – 16.5%). The length of hospital-stay after laparoscopic interventions was less than after open procedures in both groups of patients. There was no in-hospital mortality. Conclusion. Laparoscopic surgery for liver and pancreatic neoplasms is associated with significantly reduced overall morbidity and postoperative hospital-stay, accelerated rehabilitation. Laparoscopic pancreatectomy decreases incidence of postoperative pancreatic fistulae Grade A and, especially, Grade B.