scholarly journals LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE

2013 ◽  
Vol 50 (3) ◽  
pp. 214-218 ◽  
Author(s):  
Marcel Autran Cesar MACHADO ◽  
Rodrigo Canada Trofo SURJAN ◽  
Suzan Menasce GOLDMAN ◽  
Jose Celso ARDENGH ◽  
Fabio Ferrari MAKDISSI
Keyword(s):  
Blood Transfusion ◽  
Pancreatic Resection ◽  
Operative Time ◽  
Uncinate Process ◽  
Central Pancreatectomy ◽  
Endocrine Insufficiency ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Laparoscopic Pancreatic Resection ◽  
Resection Of The Pancreas ◽  
Totally Laparoscopic

Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6%) were performed totally laparoscopic; 4 (4.2%) needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%). Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

scholarly journals Robotic pancreatic resection. Personal experience with 105 cases

2020 ◽  
Vol 47 ◽  
Author(s):  
MARCEL AUTRAN CESAR MACHADO ◽  
MURILLO M LOBO FILHO ◽  
BRUNO H MATTOS ◽  
JOSÉ CELSO ARDENGH ◽  
FÁBIO FERRARI MAKDISSI
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Pancreatic Surgery ◽  
Uncinate Process ◽  
Central Pancreatectomy ◽  
Endocrine Insufficiency ◽  
Resection Of The Pancreas ◽  
Minimally Invasive Pancreatic Surgery ◽  
Robotic Resection

ABSTRACT Objective: the first robotic pancreatic resection in Brazil was performed by our team in 2008. Since March 2018, a new policy prompted us to systematically employ the robot in all minimally invasive pancreatic surgery. The aim of this paper is to review our experience with robotic pancreatic resection. Methods: all patients who underwent robotic pancreatic resection from March 2018 through December 2019 were identified. Descriptive data were collected. Preoperative variables included age, sex, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Results: 105 patients underwent robotic pancreatectomy. Median age was 60.5 years old. Fifty-five patients were female. 51 patients underwent robotic pancreatoduodenectomies, 34 distal pancreatectomy. Morbidity was 23.8%, mainly related to postoperative pancreatic fistula and one death occurred (mortality of 0.9%). Three patients (2.8%) were converted to open surgery. Four patients had delayed gastric emptying and two presented bleeding. Twenty-four patients had pancreatic fistula that was treated conservatively with late removal of the pancreatic drain. No patient required percutaneous drainage, reintervention or hospital readmission. Conclusions: the robotic platform is useful for the reconstruction of the alimentary tract after pancreatoduodenectomy or after central pancreatectomy. It may increase the preservation of the spleen during distal pancreatectomies. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency. Robotic resection of the pancreas is safe and feasible for selected patients. It should be performed in specialized centers by surgeons with experience in both open and minimally invasive pancreatic surgery.

Preoperative pancreatic duct stenting in patients undergoing laparoscopic pancreatic surgery – a preliminary report

2015 ◽  
Vol 87 (6) ◽  
Author(s):  
Mateusz Rubinkiewicz ◽  
Marcin Migaczewski ◽  
Michał Pędziwiatr ◽  
Maciej Matłok ◽  
Marcin Dembiński ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Resection ◽  
Pancreatic Surgery ◽  
Uncinate Process ◽  
The Body ◽  
Open Approach ◽  
Laparoscopic Pancreatic Surgery ◽  
Pancreatic Duct Stenting ◽  
Laparoscopic Pancreatic Resection

AbstractLaparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum.The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery.Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery.Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery.Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.

scholarly journals International Summit on Laparoscopic Pancreatic Resection (ISLPR) “Coimbatore Summit Statements”

2018 ◽  
Vol 27 (1) ◽  
pp. A10-A15 ◽  
Author(s):  
Chinnusamy Palanivelu ◽  
Kyoichi Takaori ◽  
Mohammad Abu Hilal ◽  
David A. Kooby ◽  
Go Wakabayashi ◽  
...  
Keyword(s):  
Pancreatic Resection ◽  
Laparoscopic Pancreatic Resection ◽  
International Summit

Volume-outcome Relationship in Rectal Cancer Surgery

2021 ◽  
Author(s):  
Leandro Siragusa ◽  
Bruno Sensi ◽  
Danilo Vinci ◽  
Marzia Franceschilli ◽  
Giulia Bagaglini ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Cancer Surgery ◽  
Leak Rate ◽  
Perioperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leak Rate

Abstract Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.05). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p <0.05) were also significantly reduced in Group A.Conclusion: This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures

2020 ◽  
Vol 44 (9) ◽  
pp. 1815-1822
Author(s):  
Wayne B. Cohen-Levy ◽  
Augustus J. Rush ◽  
Joshua P. Goldstein ◽  
Jonathan I. Sheu ◽  
Roberto C. Hernandez-Irizarry ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Operative Time ◽  
Acetabulum Fractures

scholarly journals Cien duodenopancreatectomías cefálicas laparoscópicas. Experiencia de dos grupos de trabajo

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Lucio Uranga ◽  
Gustavo Kohan ◽  
Luciano Bisio ◽  
Ornella Agnes Ditulio ◽  
Jorge Omar Monestés ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pancreatic Fistula ◽  
Performance Status ◽  
Technical Difficulty ◽  
Pancreatic Anastomosis ◽  
Total Hospital Stay ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Vascular Compromise ◽  
Fistula Rate ◽  
Totally Laparoscopic

Laparoscopic pancreatoduodenectomy is a challenge for the surgeon due to its technical difficulty. The learning curve is long and difficult. Objective. To show the joint experience of two surgeons in more than 100 laparoscopic pancreatoduodenectomy. Material and methods. We analysed all patients treated by laparoscopic pancreatoduodenectomy by two specialist surgeons in the period between May 2012 and May 2018. Inclusion criteria: patients with periampullary disease with indication of pancreatoduodenectomy. Exclusion criteria: patients with evident vascular compromise by images, metastatic disease or bad performance status. Results. Laparoscopic pancreatoduodenectomy was performed in 108 patients; 61 surgeries were totally laparoscopic, 35 were hybrid surgeries, and 12 were converted to open surgery. There was a significant decrease in operative time from case number 30. Twelve surgeries (11.3%) were converted. Pancreatic fistula occurred in 35 of 108 patients (32.4%). Twenty-six patients presented pancreatic fistula type A (24.1%), and 9 (8.3%) fistula B/C. The B/C fistula rate was 8.2% in laparoscopic pancreatic anastomosis, 8.6% in those reconstructed by mini-laparotomy and 8.3% in the converted patients. Reoperation was required (Dindo-Clavien 3) in 19 patients (17.5%). Mortality was 4.6% (5 patients), 2 within 30 days and 3 within 90 days. The median total hospital stay was 8.5 days (range: 4-83). Conclusion. Laparoscopic pancreatoduodenectomy is a viable and reproducible procedure that should be applied in selected cases during the learning curve, increasing its application as the number of operations carried out increases.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes ◽  
Low Grade

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most leading causes of cancer mortality worldwide. Laparoscopic pancreatic resection (LPR) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPR for PDAC. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses, aiming to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).Methods: Data of patients who underwent DP and PD for PDAC from January 2004 to February 2020 in our hospital were obtained. Baseline characteristics, intraoperative effect, postoperative recovery, and survival outcomes were compared. One-to-one PSM was used to minimize selection biases by balancing factors including age, sex, BMI, and tumor size.Results: Patient demographics were well matched after PSM. The DP subgroup included 86 LDP patients and 86 ODP patients, whereas the PD subgroup included 101 LPD patients and 101 OPD patients. Compared to ODP, LDP was associated with shorter operative time, less blood loss, and comparable overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. LPD was associated with longer operative time, less blood loss, and comparable overall morbidity. For oncological and survival outcomes, there were no significant differences in tumor sizes, R0 resection rate and tumor stage in both DP and PD subgroup. However, laparoscopic procedures seems to have an advantage over open surgery in terms of retrieved lymph node (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). There was no statistical significance between both groups in recurrence pattern, and 3-year recurrence-free and overall survival were comparable between groups.Conclusions: Both LDP and LPD are feasible and oncologically safe procedures for PDAC. Postoperative outcomes and long-term survival of LDP and LPD are not inferior or superior to open surgery. However, the short-term surgical advantage of LPD is not as obvious as LDP mainly due to the conversions. Our findings should be further evaluated by multicenter or randomized controlled trials.

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