The Current State of Minimally Invasive Distal Pancreatectomy
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MINIMALLY INVASIVE PANCREATIC SURGERY (MG HOUSE, SECTION EDITOR)
The Current State of Minimally Invasive Distal Pancreatectomy Major K. Lee IV • Charles M. Vollmer
Published online: 19 March 2013 Springer Science+Business Media New York 2013
Abstract Since its advent nearly 15 years ago, minimally invasive distal pancreatectomy has gradually increased in popularity. Numerous reports have now documented the safety and feasibility of the laparoscopic approach to left-sided pancreas resections, and large-scale comparisons have been made between the laparoscopic and open approaches regarding perioperative outcomes for both benign and malignant lesions. Furthermore, several highvolume centers have described their initial experiences with robotic distal pancreatectomy in comparison with laparoscopic and open resections. This review summarizes the literature for both laparoscopic and robotic distal pancreatectomy over the past year, highlighting novel advances. Although studies suggest that minimally invasive distal pancreatectomy is equivalent if not superior to the open approach in some respects, randomized studies are needed to best delineate the putative benefits. Keywords Laparoscopy Robotic Minimally invasive Distal pancreatectomy Comparative Pancreas resection Pancreatic cancer Spleen-preserving Preoperative factors Malignancy
Introduction Distal pancreatectomy for the resection of left-sided pancreatic lesions has been performed since the early twentieth century [1]. Compared with pancreatoduodenectomy, the lack of technically challenging anastomoses makes left-sided resection better suited for the application of minimally invasive approaches. Laparoscopic distal pancreatectomy (LDP) was first described approximately 15 years ago [2, 3]. The approach has several potential technical advantages over open resection, including better visualization and exposure of the pancreas within the retroperitoneum. Since its inception, multiple studies have documented the safety and feasibility of the laparoscopic approach [4–17], and several reports have chronicled initial experiences with robotic distal pancreatectomy (RDP) as well [18–20]. Minimally invasive distal pancreatectomy (MIDP; encompassing LDP and RDP) is steadily becoming more widespread, and with accrued experience, increasingly complex lesions are being approached. As a result, large-scale studies have emerged comparing intraoperative, postoperative, and oncologic outcomes with MIDP versus open distal pancreatectomy (ODP). This review aims to summarize the literature for MIDP over the past year, highlighting significant recent advances.
Meta-analyses Comparing Laparoscopic and Open Distal Pancreatectomy M. K. Lee IV C. M. Vollmer (&) Hospital of the University of Pennsylvania, 4 Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA 19104, USA e-mail: [email protected] M. K. Lee IV e-mail: [email protected]
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The feasibility of laparoscopic pancreatic surgery was first documented in numerous case series largely conducte
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