Top

Langenbeck's Archives of Surgery

Published in:

01-10-2013 | Review Article

Laparoscopic pancreatic resections

Authors: Dirk Bausch, Tobias Keck

Published in: Langenbeck's Archives of Surgery | Issue 7/2013

Abstract

Purpose

Pancreatic surgery is technically complex and requires considerable expertise. Laparoscopic pancreatic surgery adds the need for considerable experience with advanced laparoscopic techniques. Despite the technical difficulties, an increasing number of centers propagate the use of laparoscopy in pancreatic surgery over the last decade.

Methods

In this review, we provide an overview of the literature regarding the advantages and disadvantages of laparoscopic pancreatic surgery. Larger prospective randomized studies have emerged in the subset of laparoscopic or retroperitoneoscopic surgery for acute pancreatitis, considerable single center experience has been reported for laparoscopic pancreatic tail resection, and laparoscopic pancreatic head resection, however, is still restricted to a few experienced centers worldwide.

Results and conclusions

Laparoscopic pancreatic surgery is becoming more and more established, in particular for the treatment of benign and premalignant lesions of the pancreatic body and tail. It has been shown to decrease postoperative pain, narcotic use, and length of hospital stay in larger single center experience. However, prospective trials are needed in laparoscopic resective pancreatic surgery to evaluate its advantages, safety, and efficacy in the treatment of pancreatic neoplasms and in particular in malignant pancreatic tumors.

Farrell JJ, Brugge WR (2002) Intraductal papillary mucinous tumor of the pancreas. Gastrointest Endosc 55(6):701–714PubMedCrossRef

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484. doi:10.1016/S1470-2045(05)70221-7 PubMedCrossRef

Cuschieri A (1994) Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 39(3):178–184PubMed

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

Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2011) Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 25(5):1642–1651. doi:10.1007/s00464-010-1456-5 PubMedCrossRef

Jin T, Altaf K, Xiong JJ, Huang W, Javed MA, Mai G, Liu XB, Hu WM, Xia Q (2012) A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford) 14(11):711–724. doi:10.1111/j.1477-2574.2012.00531.x CrossRef

Jusoh AC, Ammori BJ (2012) Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 26(4):904–913. doi:10.1007/s00464-011-2016-3 PubMedCrossRef

Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41(7):993–1000. doi:10.1097/MPA.0b013e31824f3669 PubMedCrossRef

Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM (2012) Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg 35(1):1–8. doi:10.1016/j.asjsur.2012.04.001 PubMedCrossRef

10.

Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255(6):1048–1059. doi:10.1097/SLA.0b013e318251ee09 PubMedCrossRef

11.

Xie K, Zhu YP, Xu XW, Chen K, Yan JF, Mou YP (2012) Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World J Gastroenterol 18(16):1959–1967. doi:10.3748/wjg.v18.i16.1959 PubMedCrossRef

12.

Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20(4):421–428. doi:10.1007/s00534-012-0578-7 PubMedCrossRef

13.

Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785. doi:10.1016/j.jamcollsurg.2009.12.033, 786–777PubMedCrossRef

14.

Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, Daouadi M, Lee KK, Hughes SJ, Zeh HJ 3rd, Moser AJ (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg 148(6):525–531. doi:10.1001/jamasurg.2013.1673 PubMedCrossRef

15.

Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204(2):244–249. doi:10.1016/j.jamcollsurg.2006.11.002 PubMedCrossRef

16.

Morgan TL, Tomich EB (2012) Overwhelming post-splenectomy infection (OPSI): a case report and review of the literature. J Emerg Med 43(4):758–763. doi:10.1016/j.jemermed.2011.10.029 PubMedCrossRef

17.

Linet MS, Nyren O, Gridley G, Mellemkjaer L, McLaughlin JK, Olsen JH, Adami HO, Fraumeni JF Jr (1996) Risk of cancer following splenectomy. Int J Cancer 66(5):611–616. doi:10.1002/(SICI)1097-0215(19960529)66:5<611::AID-IJC5>3.0.CO;2-W PubMedCrossRef

18.

Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553PubMedCrossRef

19.

Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8(5):408–410PubMedCrossRef

20.

Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20(7):1045–1050. doi:10.1007/s00464-005-0474-1 PubMedCrossRef

21.

Lee JS, Han JH, Na GH, Choi HJ, Hong TH, You YK, Kim DG (2013) Laparoscopic pancreaticoduodenectomy assisted by mini-laparotomy. Surg Laparosc Endosc Percutan Tech 23(3):e98–e102. doi:10.1097/SLE.0b013e3182777824 PubMedCrossRef

22.

Keck T, Kuesters S, Wellner U, Hopt UT, Karcz WK (2011) Laparoscopic pylorus-preserving pancreatic head resection and hybrid open reconstruction via pancreatogastrostomy. J Gastrointest Surg 15(2):373–377. doi:10.1007/s11605-010-1363-z PubMedCrossRef

23.

Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26(9):2397–2402. doi:10.1007/s00464-012-2207-6 PubMedCrossRef

24.

Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24(7):1646–1657. doi:10.1007/s00464-009-0825-4 PubMedCrossRef

25.

Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Arch Surg 146(3):256–261. doi:10.1001/archsurg.2010.246 PubMedCrossRef

26.

Zeh HJ, Zureikat AH, Secrest A, Dauoudi M, Bartlett D, Moser AJ (2012) Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol 19(3):864–870. doi:10.1245/s10434-011-2045-0 PubMedCrossRef

27.

Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100(7):917–925. doi:10.1002/bjs.9135 PubMedCrossRef

28.

Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, Praveen Raj P (2009) Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16(6):731–740. doi:10.1007/s00534-009-0157-8 PubMedCrossRef

29.

Kendrick ML, Sclabas GM (2011) Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford) 13(7):454–458. doi:10.1111/j.1477-2574.2011.00323.x CrossRef

30.

Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145(1):19–23. doi:10.1001/archsurg.2009.243 PubMedCrossRef

31.

Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 215(6):810–819. doi:10.1016/j.jamcollsurg.2012.08.006 PubMedCrossRef

32.

Corcione F, Pirozzi F, Cuccurullo D, Piccolboni D, Caracino V, Galante F, Cusano D, Sciuto A (2013) Laparoscopic pancreaticoduodenectomy: experience of 22 cases. Surg Endosc 27(6):2131–2136. doi:10.1007/s00464-012-2728-z PubMedCrossRef

33.

Kim SC, Song KB, Jung YS, Kim YH, Parkdo H, Lee SS, Seo DW, Lee SK, Kim MH, Park KM, Lee YJ (2013) Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc 27(1):95–103. doi:10.1007/s00464-012-2427-9 PubMedCrossRef

34.

Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc. doi:10.1007/s00464-013-3101-6, In pressPubMed

35.

Ogiso S, Conrad C, Araki K, Basso V, Gayet B (2013) Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury. Ann Surg Oncol 20(9):3120. doi:10.1245/s10434-013-3058-7 PubMedCrossRef

36.

Zhao YP, Zhan HX, Zhang TP, Cong L, Dai MH, Liao Q, Cai LX (2011) Surgical management of patients with insulinomas: result of 292 cases in a single institution. J Surg Oncol 103(2):169–174. doi:10.1002/jso.21773 PubMedCrossRef

37.

Jensen RT, Cadiot G, Brandi ML, de Herder WW, Kaltsas G, Komminoth P, Scoazec JY, Salazar R, Sauvanet A, Kianmanesh R (2012) ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology 95(2):98–119. doi:10.1159/000335591 PubMedCrossRef

38.

Fendrich V, Bartsch DK (2011) Surgical treatment of gastrointestinal neuroendocrine tumors. Langenbecks Arch Surg 396(3):299–311. doi:10.1007/s00423-011-0741-7 PubMedCrossRef

39.

Hwang HK, Park JS, Kim JK, Park CM, Cho SI, Yoon DS (2012) Comparison of efficacy of enucleation and pancreaticoduodenectomy for small (<3 cm) branch duct type intraductal papillary mucinous neoplasm located at the head of pancreas and the uncinate process. Yonsei Med J 53(1):106–110. doi:10.3349/ymj.2012.53.1.106 PubMedCrossRef

40.

Turrini O, Schmidt CM, Pitt HA, Guiramand J, Aguilar-Saavedra JR, Aboudi S, Lillemoe KD, Delpero JR (2011) Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB (Oxford) 13(2):126–131. doi:10.1111/j.1477-2574.2010.00256.x CrossRef

41.

DiNorcia J, Lee MK, Reavey PL, Genkinger JM, Lee JA, Schrope BA, Chabot JA, Allendorf JD (2010) One hundred thirty resections for pancreatic neuroendocrine tumor: evaluating the impact of minimally invasive and parenchyma-sparing techniques. J Gastrointest Surg 14(10):1536–1546. doi:10.1007/s11605-010-1319-3 PubMedCrossRef

42.

Ayav A, Bresler L, Brunaud L, Boissel P (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390(2):134–140. doi:10.1007/s00423-004-0526-3 PubMedCrossRef

43.

Swaroop VS, Chari ST, Clain JE (2004) Severe acute pancreatitis. JAMA 291(23):2865–2868. doi:10.1001/jama.291.23.2865291/23/2865 PubMedCrossRef

44.

Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG (2001) Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 1(3):237–241PubMedCrossRef

45.

de Beaux AC, Palmer KR, Carter DC (1995) Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 37(1):121–126PubMedCrossRef

46.

Perez A, Whang EE, Brooks DC, Moore FD Jr, Hughes MD, Sica GT, Zinner MJ, Ashley SW, Banks PA (2002) Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 25(3):229–233PubMedCrossRef

47.

Malangoni MA, Martin AS (2005) Outcome of severe acute pancreatitis. Am J Surg 189(3):273–277. doi:10.1016/j.amjsurg.2004.11.013 PubMedCrossRef

48.

Acute Pancreatitis Classification Working Group. Revision of the Atlanta Classification of Acute Pancreatitis (2008) http://pancreasclub.com/resources/AtlantaClassification.pdf. Accessed 31 Aug 2013

49.

Werner J, Hartwig W, Hackert T, Buchler MW (2005) Surgery in the treatment of acute pancreatitis–open pancreatic necrosectomy. Scand J Surg 94(2):130–134PubMed

50.

Tzovaras G, Parks RW, Diamond T, Rowlands BJ (2004) Early and long-term results of surgery for severe necrotising pancreatitis. Dig Surg 21(1):41–46. doi:10.1159/00007582575825, discussion 46–47PubMedCrossRef

51.

Nieuwenhuijs VB, Besselink MG, van Minnen LP, Gooszen HG (2003) Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review. Scand J Gastroenterol Suppl 239:111–116PubMedCrossRef

52.

Bassi C, Butturini G, Falconi M, Salvia R, Frigerio I, Pederzoli P (2003) Outcome of open necrosectomy in acute pancreatitis. Pancreatology 3(2):128–132. doi:10.1159/00007008070080 PubMedCrossRef

53.

Slavin J, Ghaneh P, Sutton R, Hartley M, Rowlands P, Garvey C, Hughes M, Neoptolemos J (2001) Management of necrotizing pancreatitis. World J Gastroenterol 7(4):476–481PubMed

54.

Fugger R, Schulz F, Rogy M, Herbst F, Mirza D, Fritsch A (1991) Open approach in pancreatic and infected pancreatic necrosis: laparostomies and preplanned revisions. World J Surg 15(4):516–520, discussion 520–511PubMedCrossRef

55.

Sarr MG, Nagorney DM, Mucha P Jr, Farnell MB, Johnson CD (1991) Acute necrotizing pancreatitis: management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains. Br J Surg 78(5):576–581PubMedCrossRef

56.

D’Egidio A, Schein M (1991) Surgical strategies in the treatment of pancreatic necrosis and infection. Br J Surg 78(2):133–137PubMedCrossRef

57.

Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232(5):619–626PubMedCrossRef

58.

Connor S, Alexakis N, Raraty MG, Ghaneh P, Evans J, Hughes M, Garvey CJ, Sutton R, Neoptolemos JP (2005) Early and late complications after pancreatic necrosectomy. Surgery 137(5):499–505. doi:10.1016/j.surg.2005.01.003 PubMedCrossRef

59.

Besselink MG, de Bruijn MT, Rutten JP, Boermeester MA, Hofker HS, Gooszen HG (2006) Surgical intervention in patients with necrotizing pancreatitis. Br J Surg 93(5):593–599. doi:10.1002/bjs.5287 PubMedCrossRef

60.

Beger HG, Rau B, Mayer J, Pralle U (1997) Natural course of acute pancreatitis. World J Surg 21(2):130–135PubMedCrossRef

61.

Fernandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL (1998) Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 228(5):676–684PubMedCrossRef

62.

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(2):175–180PubMedCrossRef

63.

Ammori BJ (2002) Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc 16(9):1362. doi:10.1007/s00464-002-4202-9 CrossRef

64.

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(4):270–277PubMedCrossRef

65.

Fischer A, Schrag HJ, Keck T, Hopt UT, Utzolino S (2008) Debridement and drainage of walled-off pancreatic necrosis by a novel laparoendoscopic rendezvous maneuver: experience with 6 cases. Gastrointest Endosc 67(6):871–878. doi:10.1016/j.gie.2007.10.059 PubMedCrossRef

66.

Schrover IM, Weusten BL, Besselink MG, Bollen TL, van Ramshorst B, Timmer R (2008) EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Pancreatology 8(3):271–276. doi:10.1159/000134275 PubMedCrossRef

67.

Becker V, Huber W, Meining A, Prinz C, Umgelter A, Ludwig L, Bajbouj M, Gaa J, Schmid RM (2009) Infected necrosis in severe pancreatitis–combined nonsurgical multi-drainage with directed transabdominal high-volume lavage in critically ill patients. Pancreatology 9(3):280–286. doi:10.1159/000212093 PubMedCrossRef

68.

Mithofer K, Mueller PR, Warshaw AL (1997) Interventional and surgical treatment of pancreatic abscess. World J Surg 21(2):162–168PubMedCrossRef

69.

Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170(4):969–975. doi:10.2214/ajr.170.4.9530046 PubMedCrossRef

70.

Baril NB, Ralls PW, Wren SM, Selby RR, Radin R, Parekh D, Jabbour N, Stain SC (2000) Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg 231(3):361–367PubMedCrossRef

71.

Castellanos G, Serrano A, Pinero A, Bru M, Parraga M, Marin P, Parrilla P (2001) Retroperitoneoscopy in the management of drained infected pancreatic necrosis. Gastrointest Endosc 53(4):514–515PubMedCrossRef

72.

van Santvoort HC, Besselink MG, Bollen TL, Buskens E, van Ramshorst B, Gooszen HG (2007) Case-matched comparison of the retroperitoneal approach with laparotomy for necrotizing pancreatitis. World J Surg 31(8):1635–1642. doi:10.1007/s00268-007-9083-6 PubMedCrossRef

73.

Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245(6):943–951. doi:10.1097/01.sla.0000254366.19366.69 PubMedCrossRef

74.

Hocke M, Will U, Gottschalk P, Settmacher U, Stallmach A (2008) Transgastral retroperitoneal endoscopy in septic patients with pancreatic necrosis or infected pancreatic pseudocysts. Z Gastroenterol 46(12):1363–1368. doi:10.1055/s-2008-1027616 PubMedCrossRef

75.

Talreja JP, Kahaleh M (2009) Endotherapy for pancreatic necrosis and abscess: endoscopic drainage and necrosectomy. J Hepatobiliary Pancreat Surg 16(5):605–612. doi:10.1007/s00534-009-0130-6 PubMedCrossRef

76.

Seifert H, Biermer M, Schmitt W, Jurgensen C, Will U, Gerlach R, Kreitmair C, Meining A, Wehrmann T, Rosch T (2009) Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 58(9):1260–1266. doi:10.1136/gut.2008.163733 PubMedCrossRef

77.

Windsor JA (2007) Minimally invasive pancreatic necrosectomy. Br J Surg 94(2):132–133. doi:10.1002/bjs.5723 PubMedCrossRef

78.

van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Lameris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362(16):1491–1502. doi:10.1056/NEJMoa0908821 PubMedCrossRef

79.

Bausch D, Wellner U, Kahl S, Kuesters S, Richter-Schrag HJ, Utzolino S, Hopt UT, Keck T, Fischer A (2012) Minimally invasive operations for acute necrotizing pancreatitis: comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy. Surgery 152(3 Suppl 1):S128–S134. doi:10.1016/j.surg.2012.05.021 PubMedCrossRef

Title: Laparoscopic pancreatic resections
Authors: Dirk Bausch
Tobias Keck
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 7/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1108-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic pancreatic resections

Abstract

Purpose

Methods

Results and conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results and conclusions

Please log in to get access to this content

Other articles of this Issue 7/2013

Aspirin prolongs survival and reduces the number of Foxp3+ regulatory T cells in a genetically engineered mouse model of pancreatic cancer

Prognostic impact of lymph node involvement and the extent of lymphadenectomy (LAD) in adenocarcinoma of the esophagogastric junction (AEG)

Staging laparoscopy for hilar cholangiocarcinoma in 100 patients

Transvaginal specimen removal after laparoscopic distal pancreatic resection

32nd Annual Meeting of the German Association of Endocrine Surgeons (CAEK)

Laparoscopic surgery of liver tumors