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Peru N, Rebai W, Dokmak S. Laparoscopic total pancreatectomy with splenic vessels resection for pancreatic metastasis from renal cell carcinoma. J Visc Surg 2021; 158:83-84. [PMID: 33454306 DOI: 10.1016/j.jviscsurg.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- N Peru
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University of Paris, AP-HP, Clichy, France
| | - W Rebai
- Departement of digestive surgery, La Rabta hospital, Tunis, Tunisia
| | - S Dokmak
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University of Paris, AP-HP, Clichy, France.
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Abstract
Laparoscopic total pancreatectomy (LTP) is technical challenging and rarely reported in the literature. Herein, we introduced a safe and feasible approach to perform LTP basing on our own experience.Over the period of July 2015 to August 2018, we performed 13 cases of LTP at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected. The surgical procedures were also described in this study.Seven male and six female patients were included in this study. The median age of the patients was 51 years (range 29-79 years). The median operative time was 355 minutes (range 300-470 minutes). The median estimated blood loss was 200 mL (range 50-1000 mL). The median postoperative hospital stay was 17 days (range 12-23 days). One patient suffered from bile leakage and another patient suffered from delayed gastric emptying. Both patients cured with conservative therapy.Laparoscopic total pancreatectomy can be safely and feasibly performed in well-selected patients.
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Affiliation(s)
- Yunqiang Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Pan Gao
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University
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Berger M, Bellin MD, Kirchner V, Schwarzenberg SJ, Chinnakotla S. Laparoscopic-assisted versus open total pancreatectomy and islet autotransplantation: A case-matched study of pediatric patients. J Pediatr Surg 2020; 55:558-563. [PMID: 31727387 DOI: 10.1016/j.jpedsurg.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/16/2019] [Accepted: 10/19/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Total Pancreatectomy and Islet Autotransplantation (TPIAT) are a potential treatment for children with severe, refractory chronic pancreatitis. A laparoscopic-assisted approach provides a smaller incision and excellent visualization of the distal pancreas and spleen during resection. A minimally-invasive approach has proven advantageous for other pediatric procedures, but its value is unknown for this rare operation. This retrospective review compares outcomes between patients undergoing laparoscopic-assisted versus open TPIAT. STUDY DESIGN Children (n = 21) receiving laparoscopic-assisted TPIAT from 2013 to 2015 and children (n = 21) receiving open TPIAT from 2011 to 2015 were matched based on age, gender, symptom duration, previous interventions, and pancreatic fibrosis scores. Data reviewed included postoperative complications, operative time, estimated blood loss (EBL), intraoperative blood transfusions, number of islet equivalents (IEQ)/kg transplanted, hospital length-of-stay, graft function, narcotic use, and Patient Scar Assessment Questionnaire scores. Between-group differences were compared using Fisher's exact, Chi-square, and T-tests. RESULTS Surgical complications were similar between surgical groups (p = 0.35) and included wound complications (n = 11), chyle leak (n = 7), bowel obstruction (n = 5), bile leak (n = 3), gastrointestinal bleed (n = 2), and pneumonia (n = 1). There were no significant differences in operative time (p = 0.18), EBL (p = 0.96), blood transfusions (p = 0.34), IEQ/kg transplanted (p = 0.15), and hospital length-of-stay (p = 0.66). Insulin and opioid use was similar except for a slightly higher use of opioids (n = 4) at 2 years in the laparoscopic group. Patient surgical scar satisfaction was similar between groups (p = 0.26). CONCLUSIONS Outcomes for laparoscopic-assisted TPIAT appear comparable to open TPIAT. In children, a minimally-invasive approach does not compromise safety, effectiveness, or operative efficiency and may be used based on surgeon and patient preference.
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Affiliation(s)
- Megan Berger
- Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Melena D Bellin
- Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN; Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Varvara Kirchner
- Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | | | - Srinath Chinnakotla
- Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN; Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
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Abstract
RATIONALE Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. PATIENTS AND METHODS Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. DIAGNOSIS AND OUTCOMES The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. LESSONS Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.
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Umemura A, Nitta H, Takahara T, Hasegawa Y, Sasaki A. Current status of laparoscopic pancreaticoduodenectomy and pancreatectomy. Asian J Surg 2016; 41:106-114. [PMID: 27688035 DOI: 10.1016/j.asjsur.2016.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 12/22/2022] Open
Abstract
This review describes the recent advances in, and current status of, minimally invasive pancreatic surgery (MIPS). Typical MIPS procedures are laparoscopic pancreaticoduodenectomy (LPD), laparoscopic distal pancreatectomy (LDP), laparoscopic central pancreatectomy (LCP), and laparoscopic total pancreatectomy (LTP). Some retrospective studies comparing LPD or LDP and open procedures have demonstrated the safety and feasibility as well as the intraoperative outcomes and postoperative recovery of these procedures. In contrast, LCP and LTP have not been widely accepted as common laparoscopic procedures owing to their complicated reconstruction and limited indications. Nevertheless, our concise review reveals that LCP and LTP performed by expert laparoscopic surgeons can result in good short-term and long-term outcomes. Moreover, as surgeons' experience with laparoscopic techniques continues to grow around the world, new innovations and breakthroughs in MIPS will evolve. Well-designed and suitably powered randomized controlled trials of LPD, LDP, LCP, and LTP are now warranted to demonstrate the superiority of these procedures.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan.
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan
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Wang JF, Huang X, Han T, Wang XM. Application value of laparoscopic pancreatoduodenectomy. Shijie Huaren Xiaohua Zazhi 2015; 23:2624-2628. [DOI: 10.11569/wcjd.v23.i16.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the application value of laparoscopic pancreatoduodenectomy (LPD).
METHODS: Sixty-one patients who underwent pancreatoduodenectomy at our hospital were included, including 29 cases undergoing LPD and 32 cases undergoing open pancreatoduodenectomy. Operative parameters, short-term curative effect and complications were compared for the two groups.
RESULTS: Incision length, time to gastrointestinal function recovery, and frequency of analgesic drug use were significantly lower in the laparoscopic surgery group than in the open surgery group, although the operative time was significantly longer in the laparoscopic surgery group. The incidence rate of adverse reactions did not differ significantly between the laparoscopic surgery group and open surgery group (31.0% vs 37.5%), although the laparoscopic group had a significantly lower rate of incision liquefaction or bad healing (3.4% vs 9.4% OC).
CONCLUSION: LPD has comparable advantages over open surgery in terms of lower incidence of postoperative complications, while ensuring the therapeutic effect.
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Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P, Belghiti J, Sauvanet A. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg 2015; 220:831-8. [PMID: 25840531 DOI: 10.1016/j.jamcollsurg.2014.12.052] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy (LPD) is a difficult procedure that has become increasingly popular. Nevertheless, comparative data on outcomes remain limited. Our aim was to compare the outcomes of LPD and open pancreaticoduodenectomy (OPD). STUDY DESIGN Between April 2011 and April 2014, 46 LPD were performed and compared with 46 OPD, which theoretically can be done by the laparoscopic approach. Patients were also matched for demographic data, associated comorbidities, and underlying disease. Patient demographics and perioperative and postoperative outcomes were studied from our single center prospective database. RESULTS Lower BMI (23 vs 27 kg/m(2), p < 0.001) and a soft pancreas (57% vs 47%, p = 0.38) were observed in patients with LPD, but there were no differences in associated comorbidities or underlying disease. Surgery lasted longer in the LPD group (342 vs 264 minutes, p < 0.001). One death occurred in the LPD group (2.1% vs 0%, p = 0.28) and severe morbidity was higher (28% vs 20%, p = 0.32) in LPD due to grade C pancreatic fistula (PF) (24% vs 6%, p = 0.007), bleeding (24% vs 7%, p = 0.02), and revision surgery (24% vs 11%, p = 0.09). Pathologic examination for malignant diseases did not identify any differences between the LPD and OPD as far as size (2.51 vs 2.82 cm, p = 0.27), number of harvested (20 vs 23, p = 0.62) or invaded (2.4 vs 2, p = 0.22) lymph nodes, or R0 resection (80% vs 80%; p = 1). Hospital stays were similar (25 vs 23 days, p = 0.59). There was no difference in outcomes between approaches in patients at a lower risk of PF. CONCLUSIONS This study found that LPD is associated with higher morbidity, mainly due to more severe PF. Laparoscopic pancreaticoduodenectomy should be considered only in the subgroup of patients with a low risk of PF.
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Affiliation(s)
- Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
| | - Fadhel Samir Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Yacine Bensafta
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Philippe Lévy
- Department of Gastroenterology, Beaujon Hospital, Clichy, France
| | | | - Jacques Belghiti
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
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Zureikat AH, Nguyen T, Boone BA, Wijkstrom M, Hogg ME, Humar A, Zeh H. Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach. Surg Endosc 2014; 29:176-83. [PMID: 25005012 DOI: 10.1007/s00464-014-3656-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 05/16/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution's outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery. METHODS This study is a retrospective review of a prospective database of perioperative outcomes of all consecutive robotic TPs at a single institution. This included a single robotic TP with IAT performed on a twenty-year-old patient with chronic pancreatitis. RESULTS Between 2010 and January 2014, ten robotic TPs were performed (7 males, mean age 58 years), one of which included an IAT. Median body mass index was 28. Indications were intraductal papillary mucinous neoplasms (6), pancreatic adenocarcinoma (1), and chronic pancreatitis (3). The median operative time was 560 min with a median estimated blood loss of 650 ml. One case was converted to laparotomy. Ninety days mortality and Clavien III-IV complication rate were 0 and 20 %, respectively. The average length of stay was 10 ± 3 days, with only 1 readmission within 90 days. The single TP and IAT were completed successfully without conversion, and were achieved without division of the pancreatic neck thereby maintaining vascular inflow to an entire specimen up until extraction. CONCLUSION This represents the largest series of robotic TP, demonstrating its safety and feasibility. Additionally, TP and IAT using the technique described above can be recapitulated using the robotic approach.
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Affiliation(s)
- Amer H Zureikat
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 418, Pittsburgh, PA, 15232, USA,
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