Laparoscopic pancreatic resections.
Current experience with laparoscopic pancreatic resections based on the reported literature and our own experience is reviewed and indications and preoperative work-up. The technical aspects of laparoscopic pancreatic resections are described with particular reference to 70% to 80% distal pancreatectomy with en block splenectomy. The experience with distal laparoscopic pancreatic resections has been entirely favorable, with benefit to the patient in terms of postoperative recovery, minimal morbidity, and short hospital stay. Case selection is important. These operations should only be attempted by surgeons who have experience in open pancreatic surgery and who have acquired the necessary advanced laparoscopic skills. A team of two experienced surgeons who are used to working together best conducts laparoscopic pancreatic resections. The use of strategic rest breaks with desufflation of the pneumoperitoneum halfway through the surgery is recommended to prevent fatigue and to protect the patient from prolonged periods of positive-pressure pneumoperitoneum. Laparoscopic segmental pancreatic resections with or without splenic preservation should be differentiated from laparoscopic enucleation of islet cell tumors. Both benefit from the use of laparoscopic contact ultrasonography. The most common postoperative complication after laparoscopic pancreatic resection and enucleation is pancreatic fistula. The incidence of this complication may be reduced by suture closure of the transected pancreatic duct and application of fibrin glue. By contrast, our limited experience with laparoscopic pancreatico-duodenectomy has been unfavorable. With the current technology, the laparoscopic approach for this procedure is too prolonged and does not seem to offer any benefit to the patient. Its use cannot be recommended.