Article

Systematic Review of Minimally Invasive Pancreatic Resection

Cancer Biomarkers and Prevention Group, Department of Cancer Studies and Molecular Medicine, Bio centre, University of Leicester, University Road, Leicester LE1 7RH, UK.
Journal of Gastrointestinal Surgery (Impact Factor: 2.39). 02/2009; 13(6):1129-37. DOI: 10.1007/s11605-008-0797-z
Source: PubMed

ABSTRACT Pancreatic resection is associated with a significant morbidity. Efforts to reduce hospital stay and enhance recovery have seen the introduction of minimally invasive surgical techniques. This article reviews the current published literature on the safety and efficacy of minimally invasive surgery of the pancreas.
An electronic search of the PubMed and Embase databases was performed from 1996 to May 2008 to identify all relevant publications; studies meeting predefined inclusion criteria were retrieved and analyzed using a standardized protocol. Data on the safety and efficacy of minimally invasive surgery of the pancreas were recorded and analyzed.
Of 565 abstracts reviewed, 39 studies were identified as eligible for inclusion. There were 37 case series and two case control studies. Compared with open pancreatic surgery, minimally invasive pancreatic resection is similar in terms of morbidity and mortality. Blood loss and length of stay are decreased.
Laparoscopic distal pancreatic resection and enucleation of insulinoma appear to be safe procedures with reduced hospital stay, though morbidity remains significant. The evidence for laparoscopic pancreaticoduodenectomy is in its infancy, but the authors feel it is unlikely that many centers will achieve sufficient case load to make the introduction of minimally invasive resection feasible.

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    • "In 1994, Gagner and Pomp described the first laparoscopic pancreatoduodenectomy [6]. Even if large series of laparoscopic pancreatoduodenectomies, including complex operation associated with vascular resection, have been published today with comparable results to open procedures [7, 8], the safety of laparoscopic pancreatic procedure is mostly limited to distal pancreatic resections and enucleations [9]. The major problems for the spreading of laparoscopic pancreatoduodenectomy are the dissection of retroperitoneal margin, the complicated reconstruction phase (further complicated by laparoscopic instruments), the length of operating time, and the lack of scientifically proved advantages compared to the conventional open technique. "
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    ABSTRACT: During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas.
    BioMed Research International 05/2014; 2014:920492. DOI:10.1155/2014/920492 · 2.71 Impact Factor
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    • "The short term outcomes of the published series suggest less blood loss and shorter hospital stay compared to open enucleation [9] [45] with no mortality. Morbidity appears to be comparable, in particular POPF rates which remain in the region of 29% [9]. In addition, long term results are lacking in the literature. "
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    ABSTRACT: Pancreatic surgery was reported as early as 1898. Since then significant developments have been made in the field of pancreatic resections. In addition, advances in laparoscopic surgery in general have seen the description of this approach in pancreatic surgery with increasing frequency. Although there are no randomized controlled trials, several large series and comparative studies have reported on the short and long term outcome of laparoscopic pancreatic surgery. Furthermore, in the last decade published systematic reviews and meta-analyses have reported on cost effectiveness and outcomes of these procedures.
    Best practice & research. Clinical gastroenterology 02/2014; 28(1):123-132. DOI:10.1016/j.bpg.2013.11.011 · 3.28 Impact Factor
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    • "The short term outcomes of the published series suggest less blood loss and shorter hospital stay compared to open enucleation [9] [45] with no mortality. Morbidity appears to be comparable, in particular POPF rates which remain in the region of 29% [9]. In addition, long term results are lacking in the literature. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic surgery was reported as early as 1898. Since then significant developments have been made in the field of pancreatic resections. In addition, advances in laparoscopic surgery in general have seen the description of this approach in pancreatic surgery with increasing frequency. Although there are no randomized controlled trials, several large series and comparative studies have reported on the short and long term outcome of laparoscopic pancreatic surgery. Furthermore, in the last decade published systematic reviews and meta-analyses have reported on cost effectiveness and outcomes of these procedures.
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