Minimally Invasive Surgery for Pancreatic Disease - Current Status

Abstract

Laparoscopic procedures have advanced to represent the new gold standard in many surgical fields. Although application in pancreatic surgery is hampered by the friable nature of the gland and the difficulty of its exposure, advanced technology and surgeons' experience are leading to an expansion of minimally invasive pancreatic surgery. Addressing the whole range of main operative procedures, this review analyzes the literature data so far to give an overview about the current status of minimally invasive pancreatic surgery, its indications and limitations. In acute pancreatitis, a step-up approach from percutaneous drainage to retroperitoneoscopic necrosectomy seems beneficial. Transgastric necrosectomy also preserves the retroperitoneal compartment in contrast to the laparoscopic approach, which has widely been abandoned. In tumor pathology, laparoscopic access is adequate for small benign lesions in the pancreatic tail and body. Oncological outcome shows to be at least equal to the open procedure. Concerning laparoscopic pancreaticoduodenectomy, there is no evidence for a patients' benefit currently although several studies prove that it can be done.

Necrotizing Pancreatitis: Current Management and Therapies

“…The laparoscopic approach is associated with a lower incidence of new onset organ failure post-operatively when compared to the open approach [ 47 , 48 ]. The currently used technique is laparoscopic necrosectomy, using a retrogastric transmesocolic or retroperitoneal approach to the lesser sac [ 49 ]. Another alternative after the placement of the percutaneous drain would be a videoscopic-assisted retroperitoneal debridement (VARD), where a small 5 cm subcostal incision is made to allow larger pieces of solid debris to be removed.…”

Analysis of the Cost Effectiveness of Laparoscopic Pancreatoduodenectomy

“…Laparoscopic pancreatoduodenectomy (LPD) is emerging as a safe and effective option compared to open pancreatoduodenectomy (OPD), but still remains an area of significant controversy [1–4]. Several retrospective studies have shown LPD to be non-inferior in regards to morbidity and mortality when compared to OPD [5–12].…”

Open necrosectomy is feasible as a last resort in selected cases with infected pancreatic necrosis: a case series and systematic literature review

“…The traditional approach to the treatment of IPN had historically been open necrosectomy (ON) with the complete removal of the infected tissue. Nevertheless, due to the still high rates of complications and death characterizing the ON, in the last decade, it has been gradually replaced by minimally invasive procedures that seem to reduce the incidence of postoperative new-onset organ failure compared with the open procedures [ 12 , 13 , 16 – 18 ]. Less invasive procedures, indeed, have been successfully proposed and tested, such as percutaneous drainage (PD), endoscopic transgastric necrosectomy (ETN), or video-assisted retroperitoneal debridement (VARD) [ 19 , 20 ].…”