Minimally Invasive Surgery of Pancreatic Cancer: Feasibility and Rationale

Abstract

Minimally invasive pancreatic procedures, in particular minimally invasive pancreaticoduodenectomy, are amongst the most technically challenging procedures in general surgery. Accordingly, a high number of cases is required to master the procedures. Minimally invasive pancreatic surgery is well established for benign and premalignant lesions of the pancreas. Borderline resectable tumors with infiltration of the portal vein are also resected minimally invasively in specialized centers with appropriate expertise. Retrospective and registry studies demonstrate an equivalent long-term survival compared to conventional surgery. Perioperative morbidity and mortality are also equivalent, whereas minimally invasive surgery significantly reduces hospital stay. We expect more widespread use of minimally invasive pancreatic procedures in large centers.

Keywords: Laparoscopic surgery; Minimally invasive surgery; Pancreatic cancer; Robotic surgery.

Fig. 1

Parenchyma-sparing minimally invasive resection of branch-duct type IPMN. A Robotic central pancreatectomy. Lesion before resection (left, arrow). Situs after resection prior to pancreatogastrostomy of the distal pancreas (right). The proximal pancreas was transected using a covered Endo-GIA. B Robotic uncinatectomy.

Fig. 2

A, B Pancreatic cancer with portal vein infiltration prior (left) and after (right) robotic resection. A Subtotal tangential portal vein resection and reconstruction with running suture. B Subtotal tangential portal vein resection and reconstruction with a bovine pericardial patch. C Robotic distal pancreatectomy with celiac trunk resection (Appleby procedure). Intraoperative flow measurement of the proper hepatic artery (left). Celiac trunk prior to dissection (right).