During the past 20 years the application of a minimally invasive approach to pancreatic surgery has progressively increased. Distal pancreatectomy is the most frequently performed procedure, because of the absence of a reconstructive phase. However, middle pancreatectomy and pancreatoduodenectomy have been demonstrated to be safe and feasible as well. Laparoscopic distal pancreatectomy is recognized as the gold standard treatment for small tumors of the pancreatic body-tail, with several advantages over the traditional open approach in terms of patient recovery. The surgical treatment of lesions of the pancreatic head via a minimally invasive approach is still limited to a few highly experienced surgeons, due to the very challenging resection and complex anastomoses. Middle pancreatectomy and enucleation are indicated for small and benign tumors and offer the maximum preservation of the parenchyma. The introduction of a robotic platform more than ten years ago increased the interest of many surgeons in minimally invasive treatment of pancreatic diseases. This new technology overcomes all the limitations of laparoscopic surgery, but actual benefits for the patients are still under investigation. The increased costs associated with robotic surgery are under debate too. This article presents the state of the art of minimally invasive pancreatic surgery.
Laparoscopy, Robotic Surgery, Robot-Assisted Surgery, Pancreatic Surgery, minimally Invasive Surgery, Pancreatectomy
During the last 20 years the history of pancreatic surgery has undergone a revolution thanks to the introduction and diffusion of minimally invasive surgery. Traditionally the laparoscopic approach was limited to distal pancreatectomies and enucleations; conversely, laparoscopic pancreaticoduodenectomy never gained wide diffusion because of the very challenging reconstructive phase. The introduction of the robotic platform more than 10 years ago elicited an increased interest in minimally invasive pancreatic surgery. The main advantages of the robot are the restoration of eye-hand coordination, enhanced 3D vision, augmented precision in movements and improved ergonomics. The robot eventually allows one to perform a procedure more similar to open surgery but via a minimally invasive approach.
Laparoscopy is accepted as a gold standard approach for small tumors of the pancreatic body-tail thanks to its many advantages: reduced blood loss, reduced length of hospital stay and perhaps a reduction in overall complications (pancreatic fistula excluded). The robot can obtain similar outcomes, but clear advantages over the traditional laparoscopic approach are difficult to demonstrate. On the other hand, robotic surgery is commonly criticized for the costs involved. Randomized clinical trials are not available in the literature, while comparative studies are contradictory and compromised by strong bias in patient selection and data analysis. Surgery of the pancreatic head is very challenging with the laparoscopic and robotic approach too. The learning curve with this procedure is very long, so even though results are encouraging, a large and extensive diffusion is still far away. Young patients with benign or low-grade malignant pancreatic lesions are perhaps the most suitable candidates for this type of surgery.
Citation: Isacco Damoli, Giovanni Butturini, Marco Ramera et al. Minimally invasive pancreatic surgery – a review Wideochir Inne Tech Maloinwazyjne. 2015 Jul; 10(2): 141–149. doi: 10.5114/wiitm.2015.52705
Received: 2015 Jun 10; Revised: 2015 Jun 12; Accepted: 2015 Jun 14; Published online: 2015 Jul 7
Copyright: © 2015 Sekcja Wideochirurgii TChP This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
The authors declare no conflict of interest.