Laparoscopic pancreatic surgery |
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Authors: | Mori Toshiyuki Abe Nobutsugu Sugiyama Masanori Atomi Yutaka |
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Institution: | (1) Department of Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan |
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Abstract: | In the past, in the pancreas, a minimally invasive technique was only used for diagnostic laparoscopy in evaluating periampullary
malignancy. Recent advances in operative techniques and instrumentation have empowered surgeons to perform virtually all procedures
in the pancreas, including the Whipple procedure. Some of these procedures represent the most sophisticated application of
minimally invasive surgery, and their outcomes are reportedly better than those of conventional open approaches. In addition
to the evaluation of resectability in periampullary malignancy, palliative procedures, including biliary bypasses and gastrojejunostomy,
can be performed laparoscopically. Although it is reportedly feasible to perform a Whipple procedure laparescopically, no
benefit of the laparoscopic approach over the conventional open approach has been documented. Laparoscopic distal pancreatectomy,
with or without preserving the spleen, is technically easier than the Whipple procedure, and is more widely accepted. Indications
for laparoscopic distal pancreatectomy include cystic neoplasms and islet-cell tumors located in the pancreatic body or tail.
Complications of acute and chronic pancreatitis may be treated with the use of surgical laparoscopy. When infected necrotizing
pancreatitis is identified, surgical intervention for drainage and debridement is required. According to the type and location
of infected necrotizing pancreatitis, three laparoscopic operative approaches have been reported: infracolic debridement,
retroperitoneal debridement, and laparoscopic transgastric pancreatic necrosectomy. When internal drainage is indicated for
a pseudocyst, a minimally invasive technique is a promising option. Laparoscopic pseudocyst gastrostomy, cyst jejunostomy,
or cyst duodenostomy can be performed, depending on the size and location of the pseudocyst. Especially when a pseudocyst
is located in close contact with the posterior wall of the stomach, it is best drained by a pseudocyst gastrostomy, which
can also be done with the use of an intragastric operative technique. |
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Keywords: | Minimally invasive surgery Pancreas Pancreatic neoplasm Acute pancreatitis |
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