Skip to main content
SpringerLink
Log in

Minimally invasive surgery of the pancreas in progress

  • How To Do It
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic pancreatic surgery should be considered as an advanced laparoscopic procedure and should be performed only in institutions with experience in pancreatic surgery by a team with advanced laparoscopic skills.

Aim

This review discusses the current status of the laparoscopic approach for inflammatory pancreatic diseases and for benign-appearing pancreatic tumors.

Results

Laparoscopic surgery has been shown to be beneficial in patients with inflammatory tumors located in the body–tail of the pancreas for chronic pancreatitis. Furthermore, patients with pancreatic pseudocysts may be managed with laparoscopic internal drainage (to the stomach, duodenum, or jejunum). Also, laparoscopic or retroperitoneoscopic necrosectomy has been used with success in patients with necrotizing pancreatitis. At present, laparoscopic surgery has proven to be beneficial in patients with cystic pancreatic neoplasms and neuroendocrine pancreatic tumors.

Conclusions

The laparoscopic pancreatic approach was recently shown to be feasible and safe. Laparoscopy may contribute to reduced operation time and perioperative blood loss, and reduces surgical stress because of developments in devices, improvements in procedures, and advanced techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410

    CAS  PubMed  Google Scholar 

  2. Cuschieri A, Jakimowicz JJ (1998) Laparoscopic pancreatic resections. Semin Laparosc Surg 5:168–179

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. Fernandez-Cruz L, Saenz A, Astudillo E, Pantoja JP, Uzcategui E, Navarro S (2002) Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc 16:996–1003

    CAS  PubMed  Google Scholar 

  5. Heider R, Meyer AA, Galanko JA, Behrns KE (1999) Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg 229:781–787

    CAS  PubMed  Google Scholar 

  6. Bradley EL, Clements JL Jr, Gonzalez AC (1979) The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 137:135–141

    CAS  PubMed  Google Scholar 

  7. Newell KA, Liu T, Aranha GV, Prinz RA (1990) Are cystgastrostomy and cystjejunostomy equivalent operations for pancreatic pseudocysts? Surgery 108:635–639

    CAS  PubMed  Google Scholar 

  8. Spivak H, Galloway JR, Amerson JR, Fink AS, Branum GD, Redvanly RD, Richardson WS, Mauren SJ, Waring JP, Hunter JG (1998) Management of pancreatic pseudocysts. J Am Coll Surg 186:507–511

    CAS  PubMed  Google Scholar 

  9. Vitas GJ, Sarr MG (1992) Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery 111:123–130

    CAS  PubMed  Google Scholar 

  10. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL (1990) The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 170:411–417

    CAS  PubMed  Google Scholar 

  11. Beckingham IJ, Krige JE, Bornman PC, Terblanche J (1999) Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 94:71–74

    CAS  PubMed  Google Scholar 

  12. Vitale GC, Lawhon JC, Larson GM, Harrell DJ, Reed DN Jr, MacLeod S (1999) Endoscopic drainage of the pancreatic pseudocyst. Surgery 126:616–621

    CAS  PubMed  Google Scholar 

  13. Sahel J, Bastid C, Pellat B, Schurgers P, Sarles H (1987) Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 2:447–453

    CAS  PubMed  Google Scholar 

  14. Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP (1995) Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc 42:208–213

    CAS  PubMed  Google Scholar 

  15. Beckingham IJ, Krige JE, Bornman PC, Terblanche J (1999) Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 94:71–74

    CAS  PubMed  Google Scholar 

  16. Gagner M (1994) Laparoscopic transgastric cystogastrostomy for pancreatic pseudocyst. Surg Endosc 8:235 (abstract)

    Google Scholar 

  17. Way LW, Legha P, Mori T (1994) Laparoscopic pancreatic cystogastrostomy: the first operation in the new field of intraluminal laparoscopic surgery. Surg Endosc 8:235 (abstract)

    Google Scholar 

  18. Trias M, Targarona EM, Balague C, Cifuentes A, Taura P (1995) Intraluminal stapled laparoscopic cystogastrostomy for treatment of pancreatic pseudocyst. Br J Surg 82:403

    CAS  PubMed  Google Scholar 

  19. Meltzer RC, Amaral JF (1994) Laparoscopic pancreatic cystogastrostomy. Minim Invasive Ther 3:289–294

    Google Scholar 

  20. Holeczy P, Danis J (1998) Laparoscopic transgastric pancreatic pseudocystogastrostomy—first experience with extraluminal approach. Hepatogastroenterology 45:2215–2218

    CAS  PubMed  Google Scholar 

  21. Smadja C, Badawy A, Vons C, Giraud V, Franco D (1999) Laparoscopic cystogastrostomy for pancreatic pseudocyst is safe and effective. J Laparoendosc Adv Surg Tech Part A 9:401–403

    CAS  Google Scholar 

  22. Morino M, Garrone C, Locatelli L, Cavuoti G, Miglietta C (1995) Laparoscopic management of benign pancreatic cystic lesions. Surg Endosc 9:625 (abstract)

    Google Scholar 

  23. Park A, Schwartz R, Tandan V, Anvari M (1999) Laparoscopic pancreatic surgery. Am J Surg 177:158–163

    CAS  PubMed  Google Scholar 

  24. Ramachandran CS, Goel D, Arora V, Kumar M (2002) Gastroscopic-assisted laparoscopic cystogastrostomy in the management of pseudocysts of the pancreas. Surg Laparosc Endosc Percutan Tech 12:433–436

    CAS  PubMed  Google Scholar 

  25. Mori T, Abe N, Sugiyama M, Atomi Y (2002) Laparoscopic pancreatic cystgastrostomy. J Hepatobiliary Pancreat Surg 9:548–554

    PubMed  Google Scholar 

  26. Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236:149–158

    PubMed  Google Scholar 

  27. Obermeyer RJ, Fisher WE, Salameh JR, Jeyapalan M, Sweeney JF, Brunicardi FC (2003) Laparoscopic pancreatic cystogastrostomy. Surg Laparosc Endosc Percutan Tech 13:250–253

    PubMed  Google Scholar 

  28. Teixeira J, Gibbs KE, Vaimakis S, Rezayat C (2003) Laparoscopic Roux-en-Y pancreatic cyst-jejunostomy. Surg Endosc 17:1910–1913

    CAS  PubMed  Google Scholar 

  29. Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18:402–406

    CAS  PubMed  Google Scholar 

  30. Ammori BJ, El-Dhuwaib Y, Ballester P, Catton JA, Ainslie WG, Larvin M, McCloy RF, McMahon MJ (2004) Laparoscopic versus open internal drainage of pancreatic pseudocysts: a comparative study. 12th International Congress of the European Association for Endoscopic Surgery, Barcelona, Spain, June 12, p 169 (abstract)

    Google Scholar 

  31. Davila-Cervantes A, Gómez F, Chan C, Bezaury P, Robles-Díaz G, Uscanga LF, Herrera MF (2004) Laparoscopic drainage of pancreatic pseudocysts. Surg Endosc 18:1420–1426

    CAS  PubMed  Google Scholar 

  32. Shrikhande S, Friess HM, Schmidt J, Werner J, Uhl W, Büchler MW (2004) Sterile necrosis in acute necrotizing pancreatitis: current concepts and management strategies. In: Johnson CD, Imrie CW (eds) Pancreatic disease. Basic science clinical management, 1st edn. Springer, Berlin Heidelberg New York, pp 383–389

    Google Scholar 

  33. Beger HG, Isenmann R (1999) Surgical management of necrotizing pancreatitis. Surg Clin North Am 79:783–800

    CAS  PubMed  Google Scholar 

  34. Carter R (2004) Management of infected pancreatic necrosis. In: Johnson CD, Imrie CW (eds) Pancreatic disease. Basic science clinical management, 1st edn. Springer, Berlin Heidelberg New York, pp 390–399

    Google Scholar 

  35. Kellogg TA, Horvath KD (2003) Minimal-access approaches to complications of acute pancreatitis and benign neoplasms of the pancreas. Surg Endosc 17:1692–1704

    CAS  PubMed  Google Scholar 

  36. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol 170:969–975

    CAS  Google Scholar 

  37. Baron TH, Thaggard WG, Morgan DE, Stanley RJ (1996) Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 111:755–764

    CAS  PubMed  Google Scholar 

  38. Pamoukian VN, Gagner M (2001) Laparoscopic necrosectomy for acute necrotizing pancreatitis. J Hepatobiliary Pancreat Surg 8:221–223

    CAS  PubMed  Google Scholar 

  39. Alverdy J, Vargish T, Desai T, Frawley B, Rosen B (2000) Laparoscopic intracavitary debridement of peripancreatic necrosis: preliminary report and description of the technique. Surgery 127:112–114

    CAS  PubMed  Google Scholar 

  40. Horvath KD, Kao LS, Ali A, Wherry KL, Pellegrini CA, Sinanan MN (2001) Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc 15:677–682

    CAS  PubMed  Google Scholar 

  41. Gambiez LP, Denimal FA, Porte HL, Saudemont A, Chambon JP, Quandalle PA (1998) Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections. Arch Surg 133:66–72

    CAS  PubMed  Google Scholar 

  42. Castellanos G, Piñero A, Serrano A, Parrilla P (2002) Infected pancreatitis necrosis. Translumbar approach and management with retroperitoneoscopy. Arch Surg 137:1060–1063

    PubMed  Google Scholar 

  43. Carter CR, McKay CJ, Imrie CW (2000) Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg 232:175–180

    CAS  PubMed  Google Scholar 

  44. Connor S, Ghaneh P, Raraty M, Sutton R, Rosso E, Garvey CJ, Hughes ML, Evans JC, Rowlands P, Neoptolemos JP (2003) Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 20:270–277

    CAS  PubMed  Google Scholar 

  45. Connor S, Ghaneh P, Raraty M, Rosso E, Hartley MN, Garvey C, Hughes M, McWilliams R, Evans J, Rowlands P, Sutton R, Neoptolemos JP (2003) Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy. Br J Surg 90:1542–1548

    CAS  PubMed  Google Scholar 

  46. Sarr MG, Murr M, Smyrk TC, Yeo CJ, Fernandez-del-Castillo C, Hawes RH, Freeny PC (2003) Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. J Gastrointest Surg 7:417–428

    PubMed  Google Scholar 

  47. Sarr MG, Carpenter HA, Prabhakar LP, Orchard TF, Hughes S, van Heerden JA, DiMagno EP (2000) Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 231:205–212

    CAS  PubMed  Google Scholar 

  48. Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS (1999) Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23:1–16

    CAS  PubMed  Google Scholar 

  49. Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F, Mariuzzi GM, Kloppel G (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422

    CAS  PubMed  Google Scholar 

  50. Pyke CM, van Heerden JA, Colby TV, Sarr MG, Weaver AL (1992) The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 215:132–139

    CAS  PubMed  Google Scholar 

  51. Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, Pitt HA (1998) Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg 227:896–903

    CAS  PubMed  Google Scholar 

  52. Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA (2003) Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg 7:890–897

    PubMed  Google Scholar 

  53. Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168

    PubMed  Google Scholar 

  54. Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553

    CAS  PubMed  Google Scholar 

  55. Warshaw A (1997) Letter to the editor. Techniques of preserving the spleen with distal pancreatectomy. Surgery 121:974

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  57. Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg 1:20–26

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  59. Burpee S, Jossart G, Gagner M (1999) The laparoscopic approach to gastroenteropancreatic tumors. Acta Chir Austriaca 31:207–213

    Google Scholar 

  60. Azagra JS, Goergen M, Gilbart E, De Simone P, Ceuterick M, Ibanez-Aguirre J (2000) Coelio-Splénopancréatectomie corporéocaudale: technique opératoire. J Coeliochir 36:22–27

    Google Scholar 

  61. Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D (2001) Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 193:281–287

    CAS  PubMed  Google Scholar 

  62. Barlehner E, Anders S, Schwetling R (2002) Laparoscopic resection of the left pancreas: technique and indication. Dig Surg 19:507–510

    CAS  PubMed  Google Scholar 

  63. Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236:149–158

    PubMed  Google Scholar 

  64. Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc 16:1358–1361

    CAS  PubMed  Google Scholar 

  65. Gramatica L Jr, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N (2002) Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 26:1297–1300

    PubMed  Google Scholar 

  66. Marbrut JY, Boulez J, Peix JL, Gigot JF, Gouillat C, De La Roche É, Adham M, Ducerf C, Baulieux J (2003) Laparoscopic pancreatic resections [article in French]. Ann Chir 128:425–426

    PubMed  Google Scholar 

  67. Masson B, Sa-Cunha A, Laurent C, Rault A, Collet D (2003) Laparoscopic pancreatectomy: report of 22 cases [article in French]. Ann Chir 128:452–456

    CAS  PubMed  Google Scholar 

  68. Van Nieuwenhove Y, Vandaele S, Op de Beeck B, Delvaux G (2003) Neuroendocrine tumors of the pancreas. Surg Endosc 17:1658–1662

    PubMed  Google Scholar 

  69. Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18:407–411

    CAS  PubMed  Google Scholar 

  70. Mahajna A, Wintringer P, Stabilini C, Feryn T, Perissat J, Dulucq JL (2004) Major laparoscopic pancreatic resections—a prospective study of 32 patients in a single institute. 12th International Congress of the European Association for Endoscopic Surgery, Barcelona, Spain, June 12, p 172 (abstract)

  71. Kosmahl M, Klöppel G (2004) Pancreatic cystic lesions and neoplasms. In: Johnson CD, Imrie CW (eds) Pancreatic disease. Basic science clinical management, 1st edn. Springer, Berlin Heidelberg New York, pp 133–143

    Google Scholar 

  72. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797

    PubMed  Google Scholar 

  73. Fernandez-Cruz L, Saenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26:1057–1065

    CAS  PubMed  Google Scholar 

  74. Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128:386–391

    CAS  PubMed  Google Scholar 

  75. Iihara M, Obara T (2002) Minimally invasive endocrine surgery: laparoscopic resection of insulinomas. Biomed Pharmacother 56(Suppl 1):227s–230s

    PubMed  Google Scholar 

  76. Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH (1991) Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach. Surgery 110:998–1004

    CAS  PubMed  Google Scholar 

  77. Berber E, Flesher N, Siperstein AE (2002) Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg 26:985–990

    PubMed  Google Scholar 

  78. Fernández-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501

    PubMed  Google Scholar 

  79. Fernandez-Cruz L, Martinez I, Cesar-Borges G, Astudillo E, Orduña D, Halperin I, Sesmilo G, Puig M (2005) Laparoscopic surgery in patients with sporadic and multiple insulinomas associated with multiple endocrine neoplasia type I. J Gastrointest Surg 9:381–388

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, IMD, Biliary and Pancreatic Unit, Hospital Clinic i Provincial de Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain

    Laureano Fernández-Cruz, Gleydson Cesar-Borges, Miguel Angel López-Boado & David Orduña

  2. Gastroenterology Unit, Hospital Clinic i Provincial de Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain

    Salvador Navarro

Authors
  1. Laureano Fernández-Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gleydson Cesar-Borges
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Angel López-Boado
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Orduña
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Salvador Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laureano Fernández-Cruz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fernández-Cruz, L., Cesar-Borges, G., López-Boado, M.A. et al. Minimally invasive surgery of the pancreas in progress. Langenbecks Arch Surg 390, 342–354 (2005). https://doi.org/10.1007/s00423-005-0556-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-005-0556-5

Keywords

Search

Navigation