Full laparoscopic total pancreatectomy with and without spleen and pylorus preservation: a feasibility report

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 20; no. 6; pp. 647 - 653
• Main Authors: Dallemagne, Bernard, de Oliveira, AntonioTalvaneTorres, Lacerda, Croider Franco, D'Agostino, Jacopo, Mercoli, Henry, Marescaux, Jacques
• Format: Journal Article
• Language: English
• Published: Tokyo Blackwell Publishing Ltd 01-08-2013; Springer Japan; Wiley Subscription Services, Inc
• Subjects: Abdominal Surgery; Adult; Aged; endocrine pancreatic tumors; Feasibility Studies; Female; Gastroenterology; Hepatology; Humans; intraductal pancreatic mucinous neoplasm (IPMN); laparoscopic total pancreatectomy; Laparoscopy; Medicine; Medicine & Public Health; Pancreas; Pancreatectomy - methods; Pancreatic Neoplasms - surgery; Preservation; Pylorus - surgery; Spleen; Spleen - surgery; Surgical Oncology; Technical View; Laparoscopic total pancreatectomy; Intraductal pancreatic mucinous neoplasm (IPMN); Endocrine pancreatic tumors; Laparoscopy; Pancreas; laparoscopy; endocrine pancreatic tumors; laparoscopic total pancreatectomy; pancreas; intraductal pancreatic mucinous neoplasm (IPMN)
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-013-0593-3

Background/purpose
Laparoscopic pancreatic surgery is gaining acceptance and clear advantages have been demonstrated in distal resection. Total pancreaticoduodenectomy (TPD) combines the operative steps of distal pancreatectomy and pancreaticoduodenectomy, but facilitates reconstruction and lowers the risk of common complications by avoiding the need for a pancreatic anastomosis. The aim of this report is to analyse the feasibility of laparoscopic total pancreaticoduodenectomy, with and without spleen and pylorus preservation.
Methods
Two patients underwent laparoscopic TPD for pancreatic intraductal mucinous neoplasm and endocrine tumors. Total splenopancreaticoduodenectomy (TSP) and pylorus- and spleen-preserving total pancreaticoduodenectomy (PSPTP) were performed.
Results
The two procedures were successfully completed laparoscopically. PSPTP was more time-consuming (420 vs. 360 min) and had an increased risk of hemorrhage (600 vs. 200 ml) compared with TSP. After both procedures, the postoperative outcome was uneventful and the postoperative length of hospital stay was 8 days.
Conclusions
This report confirms the feasibility of full laparoscopic TPD, and presents the first full laparoscopic pylorus- and spleen-preservation technique with conservation of the splenic vessels, without robotic assistance. No conclusions can be drawn from this report, but it shows that the laparoscopic approach provides visual magnification, improved exposure, and delicate manipulation of tissues, which may reproduce the clear advantages of laparoscopic distal pancreatectomy.