Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Hepato-Biliary-Pancreatic Sciences
Published in: Journal of Hepato-Biliary-Pancreatic Sciences 6/2013

01-08-2013 | Technical view

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

Authors: Bernard Dallemagne, Antonio Talvane Torres de Oliveira, Croider Franco Lacerda, Jacopo D’Agostino, Henry Mercoli, Jacques Marescaux

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 6/2013

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.PubMed
2.
Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.PubMedCrossRef
3.
Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137:597–605.PubMedCrossRef
4.
Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145:616–21.PubMedCrossRef
5.
Ammori BJ. Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc. 2004;18:717–8.PubMedCrossRef
6.
Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B. A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg. 2008;143:289–95.PubMedCrossRef
7.
Kimura Y, Hirata K, Mukaiya M, Mizuguchi T, Koito K, Katsuramaki T. Hand-assisted laparoscopic pylorus-preserving pancreaticoduodenectomy for pancreas head disease. Am J Surg. 2005;189:734–7.PubMedCrossRef
8.
Gumbs A, Rodriguez Rivera A, Milone L, Hoffman J. Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Ann Surg Oncol. 2011;18:1–7.CrossRef
9.
Choi SH, Hwang HK, Kang CM, Yoon CI, Lee WJ. Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc. 2012;12:12.
10.
Casadei R, Marchegiani G, Laterza M, Ricci C, Marrano N, Margiotta A, et al. Total pancreatectomy: doing it with a mini-invasive approach. JOP. 2009;10:328–31.PubMed
11.
Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion severity grading system. J Am Coll Surg. 2012;215:810–9.PubMedCrossRef
12.
Giulianotti PC, Addeo P, Buchs NC, Bianco FM, Ayloo SM. Early experience with robotic total pancreatectomy. Pancreas. 2011;40(2):311–3.PubMedCrossRef
13.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.PubMedCrossRef
14.
Jensen RT, Berna MJ, Bingham DB, Norton JA. Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer. 2008;113:1807–43.PubMedCrossRef
15.
Libutti SK, Choyke PL, Bartlett DL, Vargas H, Walther M, Lubensky I, et al. Pancreatic neuroendocrine tumors associated with von Hippel Lindau disease: diagnostic and management recommendations. Surgery. 1998;124:1153–9.PubMedCrossRef
16.
Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255:1048–59.PubMedCrossRef
17.
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145:19–23.PubMedCrossRef
18.
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.PubMedCrossRef
19.
Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205:222–30.PubMedCrossRef
20.
Kim S, Song K, Jung Y, Kim Y, Park D, Lee S, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc. 2013;27:95–103.PubMedCrossRef
21.
Buchs N, Addeo P, Bianco F, Ayloo S, Benedetti E, Giulianotti P. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg. 2011;35:2739–46.PubMedCrossRef
22.
Zeh H, Zureikat A, Secrest A, Dauoudi M, Bartlett D, Moser A. Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol. 2012;19:864–70.PubMedCrossRef
23.
Kim DH, Kang CM, Lee WJ. Laparoscopic-assisted spleen-preserving and pylorus-preserving total pancreatectomy for main duct type intraductal papillary mucinous tumors of the pancreas: a case report. Surg Laparosc Endosc Percutan Tech. 2011;21:e179–82.PubMedCrossRef
24.
Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery. 1996;120:885–90.PubMedCrossRef
25.
Choi S, Hwang H, Kang C, Yoon C, Lee W. Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc. 2012;26:2072–7.PubMedCrossRef
26.
Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg. 2011;253:1136–9.PubMedCrossRef
27.
Sugiyama M, Atomi Y. Pylorus-preserving total pancreatectomy for pancreatic cancer. World J Surg. 2000;24:66–70.PubMedCrossRef
28.
Inagaki M, Obara M, Kino S, Goto J, Suzuki S, Ishizaki A, et al. Pylorus-preserving total pancreatectomy for an intraductal papillary-mucinous neoplasm of the pancreas. J Hepatobiliary Pancreat Surg. 2007;14:264–9.PubMedCrossRef
29.
Wagner M, Z’Graggen K, Vagianos CE, Redaelli CA, Holzinger F, Sadowski C, et al. Pylorus-preserving total pancreatectomy. Early and late results. Dig Surg. 2001;18:188–95.PubMedCrossRef
30.
Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg. 2002;137:164–8.PubMedCrossRef
31.
Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004;8:493–501.PubMedCrossRef
32.
Crippa S, Tamburrino D, Partelli S, Salvia R, Germenia S, Bassi C, et al. Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery. 2011;149:79–86.PubMedCrossRef
33.
Janot MS, Belyaev O, Kersting S, Chromik AM, Seelig MH, Sulberg D et al. Indications and early outcomes for total pancreatectomy at a high-volume pancreas center. HPB Surg. 2010;2010.
Metadata
Title
Full laparoscopic total pancreatectomy with and without spleen and pylorus preservation: a feasibility report
Authors
Bernard Dallemagne
Antonio Talvane Torres de Oliveira
Croider Franco Lacerda
Jacopo D’Agostino
Henry Mercoli
Jacques Marescaux
Publication date
01-08-2013
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 6/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-013-0593-3

Other articles of this Issue 6/2013

Journal of Hepato-Biliary-Pancreatic Sciences 6/2013 Go to the issue

Topics

Robotic-assisted pancreatic surgery

Topics

Understanding pancreatic cancer genomes

Original article

The impact of the Japanese clinical guidelines on the clinical management of patients with acute cholecystitis

Topics

Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

Original article

New-onset diabetes mellitus developing in Asian adult living donor liver transplant recipients: a single-center experience

Topics

Minimally invasive surgical techniques for pancreatic cancer: ready for prime time?