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      LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE Translated title: Pancreatectomia laparoscopica. Da enucleacao a duodenopancreatectomia. 11 anos de experiencia

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          Abstract

          Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6%) were performed totally laparoscopic; 4 (4.2%) needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%). Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

          Translated abstract

          Contexto Nossa experiência com ressecção pancreática laparoscópica começou em 2001. No início, a laparoscopia esteve reservada para casos selecionados. Com o aumento da experiência, procedimentos mais complexos, como pancreatectomia central e pancreato duodenectomia, foram realizadas por laparoscopia. Objetivos O objetivo deste trabalho foi rever a experiência de 11 anos com ressecção pancreática laparoscópica. Métodos Foram analisados todos os pacientes submetidos à ressecção pancreática laparoscópica entre 2001 e 2012 e incluídos dados pré-operatórios como idade, sexo e indicação cirúrgica, bem como variáveis intra-operatórias como o tempo operatório, o sangramento e transfusão. O diagnóstico final, o tamanho e a margem foram determinados a partir dos laudos anatomopatológicos. Resultados Desde 2001, 96 pacientes foram submetidos à pancreatectomia laparoscópica. A média de idade foi de 55 anos. Foram 60 homens e 36 mulheres. Oitenta e oito (91,6%) operações foram realizadas por laparoscopia e quatro (4,2%) necessitaram de auxílio da mão e uma robótica. Três pacientes foram convertidos. Quatro necessitaram de transfusão de sangue. O tempo operatório variou de acordo com tipo de operação. A mortalidade foi nula, mas a morbidade foi alta, principalmente devido à fístulas pancreáticas (28,1%). Sessenta e um pacientes foram submetidos à pancreatectomia distal, 18 à enucleação do pâncreas, 7 à duodenopancreatectomia com preservação de piloro, 5 à ressecção do processo uncinado, 3 centrais e duas pancreatectomias totais. Conclusão Ressecção laparoscópica do pâncreas é uma realidade. Técnicas que preservam o parênquima, como enucleação, ressecção do processo uncinado e pancreatectomia central, devem ser usadas para evitar insuficiência exócrina e/ou endócrina. Duodenopancreatectomia laparoscópica é operação segura, mas deve ser realizada em centros especializados e por cirurgiões laparoscópicos adequadamente treinados.

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          Laparoscopic pylorus-preserving pancreatoduodenectomy with double jejunal loop reconstruction: an old trick for a new dog.

          Pancreatoduodenectomy is an established procedure for the treatment of benign and malignant diseases located at the pancreatic head and periampullary region. In order to decrease morbidity and mortality, we devised a unique technique using two different jejunal loops to avoid activation of pancreatic juice by biliary secretion and therefore reduce the severity of pancreatic fistula. This technique has been used for open pancreatoduodenectomy worldwide but to date has never been described for laparoscopic pancreatoduodenectomy. This article reports the technique of laparoscopic pylorus-preserving pancreatoduodenectomy with two jejunal loops for reconstruction of the alimentary tract.
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            Laparoscopic resection of uncinate process of the pancreas.

            Solid pseudopapillary neoplasm of the pancreas is an uncommon but distinctive pancreatic neoplasm with low metastatic potential [1]. Therefore, whenever feasible, an organ-preserving operation should be performed. As previously reported, women with solid pseudopapillary neoplasm of the pancreas may be best treated by more conservative procedures [2]. Recently, laparoscopic pancreatic resections became more common and are being performed in highly specialized centers. There are only six cases of laparoscopic resection for solid pseudopapillary neoplasm of pancreas published in the English literature and, to our knowledge, laparoscopic resection of uncinate process of the pancreas has never been reported [3-6]. This video demonstrates the technical aspects of a totally laparoscopic resection of the uncinate process of the pancreas in a patient with solid pseudopapillary neoplasm.
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              Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ag
                Arquivos de Gastroenterologia
                Arq. Gastroenterol.
                Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE (São Paulo )
                1678-4219
                September 2013
                : 50
                : 3
                : 214-218
                Affiliations
                [1 ] Hospital Sírio-Libanês Brazil
                [2 ] Universidade Federal de São Paulo Brazil
                [3 ] Universidade de São Paulo Brazil
                Article
                S0004-28032013000300214
                10.1590/S0004-28032013000200038
                24322194
                d6a26a66-d809-4d15-a503-d296710ae9b1

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2803&lng=en
                Categories
                GASTROENTEROLOGY & HEPATOLOGY

                Gastroenterology & Hepatology
                Pancreatectomy,Pancreaticoduodenectomy,Laparoscopy,Pancreatectomia,Pancreaticoduodenectomia,Laparoscopia

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