Skip to main content

Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre

Surgical Endoscopy volume 23, Article number: 2743 (2009) Cite this article

Abstract

Background

Laparoscopic pancreatic surgery has been slow to gain wide acceptance due to the complex pancreatic anatomy and physiology. The aim of this study was to analyze our preliminary results and highlight the impact of centralization on surgeon workload and pancreatic surgical innovation.

Methods

A retrospective analysis was performed on all patients who underwent laparoscopic distal pancreatectomy from May 2007 to October 2008.

Results

Laparoscopic distal pancreatectomy was performed in 17 patients during that period. Median operative time was 180 min (range 120–300 min). Median blood loss was 100 ml (range 50–500 ml). Splenectomy was performed in 12 patients. None of the patients was converted to open operation. All patients were kept in high-dependency unit for median duration of 1 day (range 0–1 day). One patient with previous cardiac disease was kept in intensive therapy unit for one night, but discharged home on 7th postoperative day without any complications. Postoperative recovery was uneventful in 13 patients, while four patients had pancreatic leak. One pancreatic leak was observed in the last 11 patients, in which pancreatic stump was oversewn. In three patients, pancreatic leaks (PL) were minor and settled with conservative management, while one patient needed a computed tomography (CT)-guided drainage and subsequent minilaparotomy for wash out of the intra abdominal collection. None of the patients died in this series. Median hospital stay was 5 days (range 4–7 days).

Conclusions

Laparoscopic distal pancreatic resection is feasible, safe, and efficient. However, this surgery should only be performed in specialized centres with extensive experience in pancreatic and laparoscopic surgery. Oversewing the pancreatic stump after transaction with Endostapler may reduce the incidence of pancreatic leak. Centralization of pancreatic surgery has a positive impact on building up surgical expertise, resulting in obvious benefits for both patients and institutions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Takaori K, Tanigawa N (2007) Laparoscopic pancreatic resection: the past, present, and future. Surg Today 37(7):535–545

    Article  PubMed  Google Scholar 

  2. Matsumoto T, Hirano S, Yada K et al (2005) Safety and efficacy of laparoscopic distal pancreatectomy for the treatment of pancreatic disease. J Hepatobiliary Pancreat Surg 12(1):65–70

    Article  PubMed  Google Scholar 

  3. Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20(7):1045–1050

    Article  CAS  PubMed  Google Scholar 

  4. Lebedyev A, Zmora O, Kuriansky J et al (2004) Laparoscopic distal pancreatectomy. Surg Endosc 18(10):1427–1430

    Article  CAS  PubMed  Google Scholar 

  5. Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120(6):1051–1054

    Article  CAS  PubMed  Google Scholar 

  6. Warshaw AL (1998) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553

    Google Scholar 

  7. Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246(1):77–82

    Article  PubMed  Google Scholar 

  8. Cuschieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223(3):280–285

    Article  CAS  PubMed  Google Scholar 

  9. Pryor A, Means JR, Pappas TN (2007) Laparoscopic distal pancreatectomy with splenic preservation. Surg Endosc 21(12):2326–2330

    Article  CAS  PubMed  Google Scholar 

  10. Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19(8):1028–1034

    Article  CAS  PubMed  Google Scholar 

  11. Tang CN, Tsui KK, Ha JP, Wong DC, Li MK (2007) Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 54(73):265–271

    CAS  PubMed  Google Scholar 

  12. Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143(3):289–295

    Article  PubMed  Google Scholar 

  13. Fernandez-Cruz L, Orduna D, Cesar-Borges Lopez-BoadoM (2005) Distal pancreatectomy: en bloc splenectomy vs Spleen- preserving pancreatectomy. HPB 7(2):93–98

    PubMed  Google Scholar 

  14. Velanovich V (2006) Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 10(1):95–98

    Article  PubMed  Google Scholar 

  15. Shimizu S et al (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18:402–406

    Article  CAS  PubMed  Google Scholar 

  16. Mabrut JY, Cruz Fernandez, Azagra JS et al (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605

    Article  PubMed  Google Scholar 

  17. Tagaya N et al (2003) Laparoscopic resection of the pancreas and review of the literature. Surg Endosc 17:201–206

    Article  CAS  PubMed  Google Scholar 

  18. Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of spleen for distal pancreas tumour. Surg Endosc 13:26–29

    Article  CAS  PubMed  Google Scholar 

  19. Patterson EJ et al (2001) Laparoscopic pancreatic resection: single institution experience of 19 patients. J Am Coll Surg 193:281–287

    Article  CAS  PubMed  Google Scholar 

  20. Farbe JM et al (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc 16:1358–1361

    Article  Google Scholar 

  21. Hemandas AK, Jain G, Fong F, Stedman B, Jaynes E, Abu Hilal M (2008) Feasibility of laparoscopic distal spleno-pancreatectomy following previous necrosectomy A case report. JOP 9(5):644–648

    PubMed  Google Scholar 

  22. Birkmeyer JD et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137

    Article  PubMed  Google Scholar 

  23. Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF (2002) The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 131(1):6–15

    Article  PubMed  Google Scholar 

  24. Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V (2008) Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg 95(3):357–362

    Article  CAS  PubMed  Google Scholar 

  25. Heek Van et al (2005) Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in The Netherlands. Ann Surg 242(6):781–790

    Article  PubMed  Google Scholar 

  26. Topal B, Van de Sande S, Fieuws S, Penninckx F (2007) Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br J Surg 94(11):1377–1381

    Article  CAS  PubMed  Google Scholar 

  27. Pierce RA, Spitler JA, Hawkins WG (2007) Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 21(4):579–586

    Article  CAS  PubMed  Google Scholar 

  28. Matsumoto T et al (2002) Pancreatic resection with ultrasonically activated scalpel: preliminary observation. Hepatogastroenterology 49:635–638

    PubMed  Google Scholar 

  29. Lillemore KD, Kaushal S, Cameron JL et al (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698

    Article  Google Scholar 

  30. Bassi C, Butturini G, Falconi M et al (1999) Prospective randomized pilot study of management of the pancreatic stump following distal resection. HPB 1:203–207

    Google Scholar 

Download references

Author information

Affiliations

  1. Hepato pancreatico biliary Unit, Surgical Academic Unit, F Level Southampton General Hospital, Southampton, UK

    Mohammed Abu Hilal, Gaurav Jain, Farhan Kasasbeh, Massimiliano Zuccaro & Hassan Elberm

  2. School of Medicine, Southampton University, University Surgical Unit, F Level Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Mohammed Abu Hilal

Authors
  1. Mohammed Abu Hilal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaurav Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farhan Kasasbeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimiliano Zuccaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hassan Elberm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammed Abu Hilal.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Abu Hilal, M., Jain, G., Kasasbeh, F. et al. Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg Endosc 23, 2743 (2009). https://doi.org/10.1007/s00464-009-0499-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00464-009-0499-y

Keywords

  • Laparoscopic distal pancreatectomy
  • Pancreatic cancer
  • Pancreatic surgery
  • Pancreatic leak