Laparoscopic Uncinatectomy: A More Conservative Approach to the Uncinate Process of the Pancreas

Abstract

Background: The isolate resection of the uncinate process of the pancreas is a rarely described procedure but is an adequate surgery to treat benign and low grade malignancies of the uncinate process of the pancreas. Aim: To detail laparoscopic uncinatectomy technique and present the initial results. Method: Patient is placed in supine position with the surgeon between legs. Three 5-mm, one 10-mm and one 12-mm trocars were used to perform the isolated resection of the uncinate process of the pancreas. Parenchymal transection is performed with harmonic scalpel. A hemostatic absorbable tissue is deployed over the area previously occupied by the uncinate process. A Waterman drain is placed. Result: This procedure was applied to an asymptomatic 62-year-old male with biopsy proven low grade neuroendocrine tumor of the pancreatic uncinate process. A laparoscopic pancreaticoduodenectomy was proposed. During the initial surgical evaluation, intraoperative sonography was performed and disclosed that the lesion was a few millimeters away from the Wirsung. The option was to perform a laparoscopic uncinatectomy. Postoperative period until full recovery was swift and uneventful. Conclusion: Laparoscopic uncinatectomy is a safe and efficient procedure when performed by surgical teams with large experience in minimally invasive biliopancreatic procedures.

Magnetic Resonance Cholangiopancreatography (Mrcp) Versus Endosonography-Guided Fine Needle Aspiration (Eus-Fna) for Diagnosis and Follow-Up of Pancreatic Intraductal Papillary Mucinous Neoplasms

“…Thus, it is important for the surgeon to apply the best possible diagnostic method through imaging tests available in clinical practice to accurately determine the diagnosis, characterization, extent, and type of tumor 2 . These factors have important implications, especially in the elderly with comorbidities, to establish a correct stratification of the risk of developing pancreatic cancer and to determine the best treatment in an individualized way 16 , 28 .…”

“…The head of the pancreas, uncinate process, common bile duct, duodenal papilla and gall bladder were visualized and examined through the duodenum. The tail and body of the pancreas, celiac trunk, superior mesenteric artery and adjacent structures were examined through the gastric chamber 28 . The puncture was performed at the end of the procedure after administration of antibiotic prophylaxis with the use of ciprofloxacin hydrochloride 400 mg (Cipro ® - Bayer Pharma) intravenously, dose of attack.…”

“…The increased use of computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) has increased the recognition of pancreatic cystic lesions, classified as neoplastic and pseudocyst 6 , 8 , 21 , 28 . The most common cystic neoplasms are: serous cystic neoplasia, mucinous, solid-cystic pseudopapillary (Frantz) and papilliferous mucinous mucinous intraductal neoplasia (NIMP) 2 , 15 , 31 .…”

Pancreatic Neuroendocrine Tumors: Surgical Resection

“…SRS has sensitivity of 80% for well differentiated tumors (grades 1 and 2); however, it presents lower sensitivity for tumors with a diameter smaller than 1 cm, non-metastatic insulinomas 21 and TNEs with high Ki-67 1 index. Positron emission tomography/computed tomography (PET-CT) with Gallium-68 has a greater sensitivity for the detection of NSC-P than SRS, reaching more than 90% 21 . PET-CT with fluorodeoxyglucose has better uptake in more aggressive TNEs and less efficacy in tumors grade 1 and 2 due to its limited growth rate 21 .…”

“…Positron emission tomography/computed tomography (PET-CT) with Gallium-68 has a greater sensitivity for the detection of NSC-P than SRS, reaching more than 90% 21 . PET-CT with fluorodeoxyglucose has better uptake in more aggressive TNEs and less efficacy in tumors grade 1 and 2 due to its limited growth rate 21 . Imaging evaluation is recommended for patients with metastatic disease (more common in the liver and less in the retroperitoneal lymph nodes and bones) 19 , as well as those with no metastatic disease.…”