Pancreatic Surgery

Abstract

Pancreatic surgery is an extremely challenging field, partly owing to the retroperitoneal location of the pancreas, the wide range and influence of operation, numerous postoperative complications and so on. The application of laparoscopic surgery for the treatments of pancreatic diseases is only recently gaining widespread popularity. These included diagnostic explorative laparoscopy for cancer staging (Kim et al., Curr Probl Surg 44(4):228–269, 2007; Ahmed et al., J Laparoendosc Adv Surg Tech A 16:458–463, 2006) pancreatic drainage (Hauters et al., Surg Endosc 18:1645–1648, 2004), enucleation (Toniato et al., World J Surg 30:1916–1919, 2006), distal pancreatectomy (Melotti et al., Ann Surg 246:77–82, 2007; Uranues et al., Am J Surg 192:257–261, 2006), and even pancreaticoduodenectomy (Palanivelu et al., J Am Coll Surg 205:222–230, 2007). Among these different laparoscopic procedures, laparoscopic distal pancreatectomy (LDP) is the most widely used, possibly because of its acceptable technical feasibility without the necessity for anastomoses (Park et al., Am J Surg 177:158–163, 1999).

Distal pancreatectomy has been performed since early twentieth century (Finney, Ann Surg 51:818–829, 1910). In 1994, the laparoscopic distal pancreatectomy (LDP) was first reported to be feasible and safe in a porcine model (Soper et al., Surg Endosc 8:57–60, 1994). Then, the LDP was quickly attempted to perform in humans (Cuschieri et al., Ann Surg 223:280–285, 1996; Gagner et al., Surgery 120:1051–1054, 1996; Sussman et al., Aust N Z J Surg 66(6):414–416, 1996). With better improvement of technologies, like ultrasonography, staplers, and other instrumentations, the multiple incision laparoscopic distal pancreatectomy (LDP) rapidly gained popularity, and is becoming a more widely used approach. Multiple prospective studies have shown the feasibility and safety of LDP in single-center and multicenter settings (Kooby et al., Ann Surg 248:438–446, 2008; Røsok et al., Br J Surg 97:902–909, 2010; Kneuertz et al., J Am Coll Surg 215:167–176, 2012). Now, the application of laparoscopic surgery for the distal pancreatectomy seems to become a trend in surgical technique, and might be considered as the first approach for distal pancreatectomy in the near future (Jin et al., HPB (Oxford) 14:711–724, 2012).

For a more cosmetic result and further minimizing the surgical trauma, a new minimally invasive technique called “single-incision laparoscopic surgery” (SILS) has been rapidly developed recently, and until now this approach has been performed in a variety of organs. SILS performed on the pancreatic lesions has been reported only recently, and only five cases were reported in the literature (Barbaros et al., JSLS 14:566–570, 2010; Kuroki et al., Hepatogastroenterology 58(107–108):1022–1024, 2011; Chang et al., Minim Invasive Surg 2012:197429, 2012; Misawa et al., Asian J Endosc Surg 5:195–199, 2012). However, these data might still be able to suggest that the transumbilical single-incision laparoscopic distal pancreatectomy (TUSI-LDP) is feasible, as in these reports even for the patients that had previously undergone a nephrectomy which caused dense fibrosis in the retroperitoneal region (Barbaros et al., JSLS 14:566–570, 2010), or that had two previous laparoscopic procedures for pelvic inflammatory disease and excision of ovarian cyst (Chang et al., Minim Invasive Surg 2012:197429, 2012), a SILS pancreatectomy could also be smoothly performed, and the TUSI-LDP together with splenectomy or spleen and spleen vessels preserving distal pancreatectomy were all performed successfully (Barbaros et al., JSLS 14:566–570, 2010; Kuroki et al., Hepatogastroenterology 58(107–108):1022–1024, 2011; Chang et al., Minim Invasive Surg 2012:197429, 2012; Misawa et al., Asian J Endosc Surg 5:195–199, 2012).