Context:Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction.Case Report:A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes.Conclusions:Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.
#2017-204:
There is a growing recognition of the role science plays in supporting oil spill response coupled with increasing reliance on data-driven management and decision-making approaches. Collecting samples for analysis of hydrocarbons and other chemicals potentially used during oil spill response (e.g., dispersants) has become common place on many spills. While the rationale and approaches for oil spill sampling may be well known to experienced chemists and environmental scientists, the response community is still gaining experience in integrating sampling programs into dynamic oil spill response and decision-making. This paper reviews common sampling objectives for three key aspects of spill response: operational decision-support, environmental impact assessment (including natural resource damage assessment), and source identification. These broad categories span a range of interrelated sub-topics including, among others, public/worker health and safety; understanding how physical and chemical properties of oil influence selection of response options; monitoring cleanup effectiveness, especially for alternative response technologies such as dispersants; identifying and differentiating between spill and non-spill pollution sources; and evaluating potential impacts to resources at risk. Methods for achieving sampling objectives, including development of Sampling and Analysis Plans, are discussed with the goal of increasing awareness among response managers and improving response capability among staff who may be tasked with sampling support during training exercises or actual incidents. Relevant considerations for study design, collection methods, and analytical parameters are also reviewed.
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