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Rege S, Banker A, Shah S, Bhesania D. Long-term outcomes of laparoscopic longitudinal pancreatojejunostomy and modified Frey's procedure for patients of chronic pancreatitis: A 10-year experience. J Minim Access Surg 2024; 20:74-80. [PMID: 37843167 PMCID: PMC10898633 DOI: 10.4103/jmas.jmas_282_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION To mitigate the morbidity associated with open procedures for chronic pancreatitis (CP), there is a paradigm shift towards the laparoscopic approach. However, since these procedures are technically demanding, literature is still limited. We present our experience and long-term outcomes in the management of CP with laparoscopic surgical procedures. PATIENTS AND METHODS This is a retrospective observational study of patients who underwent a laparoscopic surgery for CP between 2009 and 2019. Pain scores using the Visual Analogue Scale (VAS) were compared pre- and postoperatively. In patients with diabetes, the pre- and post-operative insulin requirement was compared. RESULTS Data of 62 patients were analysed. The mean duration of follow-up was 69 (±22) months. All patients had pain relief post-surgery. The relief of pain was sustained, with the median VAS scores being 1 at 3- and 5-year follow-up. There was a decrease in the median insulin requirement of diabetic patients, which was significant at 3-month and 1-year follow-up ( P < 0.05). CONCLUSION Our study demonstrates that laparoscopic surgical procedures offer long-term pain control with low morbidity. Effective ductal decompression may result in a short-term improvement of the endocrine function of the gland.
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Affiliation(s)
- Sameer Rege
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Amay Banker
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Sulay Shah
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Dhaval Bhesania
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
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Kalayarasan R, Shukla A. Changing trends in the minimally invasive surgery for chronic pancreatitis. World J Gastroenterol 2023; 29:2101-2113. [PMID: 37122602 PMCID: PMC10130972 DOI: 10.3748/wjg.v29.i14.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/21/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of life. Conventional management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic intervention. Traditionally surgery is reserved for patients who do not improve with other interventions. However, recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic function. Despite the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders, minimally invasive surgery for chronic pancreatitis is slow to evolve. Technical difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic pancreatitis. With this background, the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis. A Pub Med search of all relevant articles was performed using the appropriate keywords, parentheses, and Boolean operators. Most initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy, considered an adequate procedure only in a small proportion of patients. The pancreatic head is the pacemaker of pain, so adequate decompression is critical for long-term pain relief. Recent studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head resection. With improvements in laparoscopic instrumentation and technological advances, minimally invasive surgery for chronic pancreatitis is gaining momentum. However, more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.
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Affiliation(s)
- Raja Kalayarasan
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Ankit Shukla
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
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3
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Anand U, Khandelwal C, Senthilnathan P, Sabnis SC, Palanivelu C, Kumar B, Kumar R, Priyadarshi RN, Parasar K. The Current Concepts and Management of Idiopathic (Tropical) Chronic Pancreatitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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Training and learning curves in minimally invasive pancreatic surgery: from simulation to mastery. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Ramia JM, Azagra JS, De la Plaza R, Manuel A, Latorre R, Lopez-Marcano A. Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: Systematic review of the literature. Surgeon 2020; 18:137-141. [PMID: 31445938 DOI: 10.1016/j.surge.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Longitudinal pancreaticojejunostomy, also known as modified Puestow or Partington-Rochelle procedure, is a technique for the treatment of chronic pancreatitis. It is usually performed by laparotomy, but in a very small number of cases it has been performed using a laparoscopic or robot-assisted approach. We carried out a systematic literature review to clarify the current status of laparoscopic longitudinal pancreatojejunostomy (LLPJ). METHODS Adhering to the PRISMA guidelines, a systematic search for LLPJ was performed in PubMed, Embase, and Cochrane Library, for articles published up to 31 December 2017. RESULTS 357 articles were evaluated for eligibility and 17 were included for critical appraisal: eight case reports, eight retrospective case series, and one series of cases and controls without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to the CEBM. Patients were relatively young (mean age 37 years), with a slight preponderance of males (ratio 1.3: 1). All had long-standing disease, ERCP prior to surgery and a dilated pancreatic duct (mean 11 mm). The surgery was usually performed laparoscopically using four trocars; the conversion rate was low (5%), bleeding was minimal, the morbidity rate was 11% and no mortality was reported. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short (less than two years). The results for pain control were very good since 90% of patients reported no pain, although visual analog scales were rarely used. CONCLUSIONS In conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.
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Affiliation(s)
- Jose M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - J S Azagra
- Department of Surgery, Centre Hospitalier du Luxembourg, Luxembourg
| | - R De la Plaza
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Manuel
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - R Latorre
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Lopez-Marcano
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Senthilnathan P, Subrahmaneswara Babu N, Vikram A, Sabnis SC, Srivatsan Gurumurthy S, Anand Vijai N, Nalankilli VP, Palanivelu C. Laparoscopic longitudinal pancreatojejunostomy and modified Frey's operation for chronic calcific pancreatitis. BJS Open 2019; 3:666-671. [PMID: 31592076 PMCID: PMC6773625 DOI: 10.1002/bjs5.50185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chronic pancreatitis is a debilitating disease presenting with pain, diabetes and steatorrhoea. Surgery offers better long-term pain relief than other interventions, but there is still uncertainty about the optimal surgical procedure and approach and a lack of long-term follow-up data in patients with chronic calcific pancreatitis selected for laparoscopic surgical treatment. Methods This was an observational cohort study of patients who underwent laparoscopic surgery for chronic calcific pancreatitis between January 2006 and April 2017, and had completed a minimum follow-up of 1 year at a tertiary-care teaching institute. Eligibility for the laparoscopic approach was main duct diameter greater than 7 mm, absence of extensive head calcification, size of head less than 3·5 cm, absence of local complications, and ASA grade I or II status. The primary outcome variable was a reduction in pain score by 1 year. Secondary outcomes were hospital stay, complications, pain score at 3 and 5 years, and the development or progression of exocrine and endocrine insufficiency. Results Some 57 patients were scheduled to undergo laparoscopic surgery for chronic pancreatitis: longitudinal pancreatojejunostomy (39), modified Frey's procedure (15) and pancreatoduodenectomy for suspicion of malignancy (3). The latter three patients were excluded from the analysis. Conversion to open surgery was needed in ten of the 57 patients (18 per cent). The mean(s.d.) age of the analysed cohort was 34·2(3·7) years and there was a predominance of men (34, 63 per cent). Adequate pain relief was achieved in 91, 89 and 88 per cent of patients at 1, 3 and 5 years of follow-up respectively. Conclusion Laparoscopic surgical management of chronic calcific pancreatitis with longitudinal pancreatojejunostomy or modified Frey's procedure is feasible, safe and effective in selected patients for the relief of pain.
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Affiliation(s)
- P. Senthilnathan
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - N. Subrahmaneswara Babu
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - A. Vikram
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - S. C. Sabnis
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - S. Srivatsan Gurumurthy
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - N. Anand Vijai
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - V. P. Nalankilli
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
| | - C. Palanivelu
- Department of Surgical Gastroenterology and HPB SurgeryGEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, CoimbatoreTamil Nadu–641045India
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Laparoscopic Lateral Pancreaticojejunostomy—the Technique and Early Experience. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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8
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Kaushal-Deep SM, Singh V, Mani R, Gupta P, Lodi M. Negotiating the Curve of Laparoscopic Hepatopancreaticobiliary Procedures (Basic to Advanced) at a Tertiary Rural Teaching Institute. Int J Appl Basic Med Res 2019; 8:237-243. [PMID: 30598911 PMCID: PMC6259292 DOI: 10.4103/ijabmr.ijabmr_399_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: We present here our experience of laparoscopic hepatopancreaticobiliary (HPB) surgeries at our rural institute and the hurdles we faced overcoming the various challenges. Aims and Objectives: The objectives of this study were to assess the feasibility, successful completion, operative time, conversions/requirement of assistance, duration of hospital stay, and postoperative complications on the HPB procedures performed laparoscopically in our surgical unit; and to help young surgeons for smooth navigation through their laparoscopic career. Materials and Methods: All the patients admitted under our unit over the past 9 years for elective HPB surgeries operated by a single surgeon were included in this study. Results: Total 1304 basic laparoscopic biliary procedures were successfully completed laparoscopically. After getting well versed with the standard procedure, we switched over to difficult cases involving densely adhered gallbladder, frozen Calot's, Mirizzi's syndrome, use of intraoperative cholangiogram, and take down of cholecystoduodenal fistulas. Next step in evolution was doing laparoscopic common bile duct exploration and biliary procedures with decreased number of ports. Five hundred and sixty-eight procedures were advanced HPB surgeries. With time, we also started performing a variety of complex advanced laparoscopic procedures such as cystogastrostomy, hepaticojejunostomy, choledochoduodenostomy, and pancreaticojejunostomy. All these procedures have been discussed with respect to operative duration, conversion rates, blood loss, hospital stay, and complication rates in the initial and later parts of the learning curves and further compared with previous standard large case studies on specific surgeries. Conclusion: Several hurdles are met in a new institute, that too, a rural one. The present discussion will help the budding surgeons to identify their deficiencies and chart a way forward in a systematic scientific manner.
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Affiliation(s)
| | - Vikas Singh
- Department of Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Rudra Mani
- Department of Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Poonam Gupta
- Department of Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Mehershree Lodi
- Department of Anesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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9
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Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique. Surg Endosc 2018; 33:1749-1756. [PMID: 30194645 DOI: 10.1007/s00464-018-6434-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic pancreatitis (CP) is a debilitating condition resulting in severe pain with progressive deterioration of pancreatic function. "Tropical" pancreatitis represents a variant of the disease with widely dilated ducts, numerous calculi, and few strictures. Traditionally, modified Puestow's procedure has been the treatment of choice for a dilated pancreatic ductal system. However, it has only recently been adapted to laparoscopic approach which is a technically demanding procedure primarily due to need for extensive intra-corporeal suturing. METHODS Symptomatic cases of CP presenting at our center with minimum 8 mm mean ductal diameter at body and head were selected for laparoscopic modified Puestow's procedure. Those with prior pancreatic surgery, pancreatic head masses, endoscopic pancreatic stenting, and portal hypertension were excluded. Twenty-eight cases meeting selection criteria underwent a laparoscopic procedure. RESULTS Seven patients (25%) underwent a stapled pancreaticojejunal anastomosis, 17 (60.7%) received a sutured anastomosis. Four patients (14.3%) were converted to open surgery due to failure to localize the pancreatic duct with percutaneous needle aspiration. Of those patients who underwent a successful laparoscopic procedure, a single patient developed a pancreatic fistula which resolved spontaneously; another patient had a difficult post-operative course with prolonged intensive care. We suffered no mortality within the series and no patient had any long-term disability. Anastomotic patency rates of 100% were achieved by the third post-operative month. CONCLUSION Lateral pancreaticojejunostomy is an effective surgical management for CP with a dilated ductal system. Its laparoscopic adoption is the rational next surgical step. It allows effective duct decompression with low mortality and morbidity. The procedure demands an advanced surgical skill set with an emphasis on intra-corporeal suturing. Those patients suffering from tropical CP with wide ductal dilatation greater than 12 mm are suited to an endostapled anastomosis which helps significantly reduce operative time without any corrosion of outcomes.
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10
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Shah AA, Petrosyan M, Kane TD. Lateral Pancreaticojejunostomy for Chronic Pancreatitis and Pancreatic Ductal Dilation in Children. J Laparoendosc Adv Surg Tech A 2018; 28:1397-1402. [PMID: 29873622 DOI: 10.1089/lap.2018.0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Pancreatic ductal obstruction leading to ductal dilation and recurrent pancreatitis is uncommon in children. Treatment is dependent upon etiology but consists of decompression of the pancreatic duct (PD) proximally, if possible, by endoscopic retrograde cholangiopancreatography (ERCP) intervention or surgical decompression with pancreaticojejunal anastomosis. METHODS After institutional review board approval, we retrospectively reviewed the records for 2 children who underwent lateral pancreaticojejunostomy for pancreatic ductal dilation. Data, including demographics, diagnostic studies, operative details, complications, outcomes, and follow-up, were analyzed. RESULTS Case 1 was a 4-year-old female with pancreatic ductal obstruction with multiple episodes of recurrent pancreatitis and failure of ERCP to clear her PD of stones. She underwent a laparoscopic cholecystectomy with a lateral pancreaticojejunostomy (Puestow procedure). She recovered well with no further episodes of pancreatitis and normal pancreatic function 4 years later. Case 2 was a 2-year-old female who developed recurrent pancreatitis and was found to have papillary stenosis and long common bile-PD channel. Despite multiple sphincterotomies, laparoscopic cholecystectomy, and laparoscopic hepaticoduodenostomy, she continued to experience episodes of pancreatitis. She underwent a laparoscopy converted to open lateral pancreaticojejunostomy. Her recovery was also smooth having had no episodes of pancreatitis or hospital admissions for over 2 years following the Puestow. CONCLUSIONS Indication for lateral pancreaticojejunostomy or Puestow procedure is rare in children and even less often performed using laparoscopy. In our small experience, both patients with pancreatic ductal obstruction managed with Puestow's procedure enjoy durable symptom and pain relief in the long term.
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Affiliation(s)
- Adil A Shah
- 1 Department of Surgery, Howard University Hospital and College of Medicine , Washington, District of Columbia.,2 Department of Pediatric Surgery, Children's National Medical Center , George Washington University School of Medicine, Washington, District of Columbia
| | - Mikael Petrosyan
- 2 Department of Pediatric Surgery, Children's National Medical Center , George Washington University School of Medicine, Washington, District of Columbia
| | - Timothy D Kane
- 2 Department of Pediatric Surgery, Children's National Medical Center , George Washington University School of Medicine, Washington, District of Columbia
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Izrailov RE, Tsvirkun VV, Alikhanov RB, Andrianov AV. [Laparoscopic pancreatic head resection]. Khirurgiia (Mosk) 2018:45-51. [PMID: 29460878 DOI: 10.17116/hirurgia2018245-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze the features and efficacy of laparoscopic Frey procedure. MATERIAL AND METHODS For the period from August 2012 to May 2017 Frey procedure was carried out in 31 patients with chronic calculous pancreatitis Buchler type C. There were 20 men and 11 women aged 48.6±9 years. Mean pancreatic head dimension was 35.5±14 mm, diameter of the main pancreatic duct - 9.6±2.7 mm. RESULTS Completely laparoscopic procedure was made in 28 (90.3%) cases. One patient required intraoperatively Beger's technique without conversion. The last was need in 2 (6.5%) cases. Time of surgery and blood loss were 447.3±90.4 min and 215±177.7 ml respectively. Mean postoperative hospital-stay was 8.4±4.5 days. Postoperative complications occurred in 7 patients. Mortality was absent. Follow-up was 1-41 months. Recurrent pain syndrome was observed in 1 case. However, it was less severe and does not require analgesia.
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Affiliation(s)
- R E Izrailov
- Loginov Moscow Clinical Research Center of Moscow Healthcare Department, Moscow, Russia
| | - V V Tsvirkun
- Loginov Moscow Clinical Research Center of Moscow Healthcare Department, Moscow, Russia
| | - R B Alikhanov
- Loginov Moscow Clinical Research Center of Moscow Healthcare Department, Moscow, Russia
| | - A V Andrianov
- Loginov Moscow Clinical Research Center of Moscow Healthcare Department, Moscow, Russia
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Hamad A, Zenati MS, Nguyen TK, Hogg ME, Zeh HJ, Zureikat AH. Safety and feasibility of the robotic platform in the management of surgical sequelae of chronic pancreatitis. Surg Endosc 2017; 32:1056-1065. [PMID: 29273874 DOI: 10.1007/s00464-017-6010-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM The application of minimally invasive surgery to chronic pancreatitis (CP) procedures is uncommon. Our objective was to report the safety and feasibility of the robotic approach in the treatment of surgical sequelae of CP, and provide insights into the technique, tricks, and pitfalls associated with the application of robotics to this challenging disease entity. METHODS A retrospective review of a prospectively maintained database of patients undergoing robotic-assisted resections and/or drainage procedures for CP at the University of Pittsburgh between May 2009 and January 2017 was performed. A video of a robotic Frey procedure is also shown. RESULTS Of 812 robotic pancreatic resections and reconstructions 39 were for CP indications. These included 11 total pancreatectomies [with and without auto islet transplantation], 8 Puestow procedures, 4 Frey procedures, 6 pancreaticoduodenectomies, and 10 distal pancreatectomies. Median age was 49, and 41% of the patients were female. The most common etiology for CP was idiopathic pancreatitis (n = 16, 46%). Median operative time was 324 min with a median estimated blood loss of 250 ml. None of the patients required conversion to laparotomy. A Clavien III-IV complication rate was experienced by 5 (13%) patients, including one reoperation. Excluding the eleven patients who underwent TP, rate of clinically relevant postoperative pancreatic fistula was 7% (Grade B = 2, Grade C = 0). No 30 or 90 day mortalities were recorded. The median length of hospital stay was 7 days. CONCLUSIONS Use of the robotic platform is safe and feasible when tackling complex pancreatic resections for sequelae of chronic pancreatitis.
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Affiliation(s)
- Ahmad Hamad
- Division of Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, Pittsburgh, PA, 15232, USA
| | - Mazen S Zenati
- Division of Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, Pittsburgh, PA, 15232, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trang K Nguyen
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa E Hogg
- Division of Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, Pittsburgh, PA, 15232, USA
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, Pittsburgh, PA, 15232, USA
| | - Amer H Zureikat
- Division of Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, Pittsburgh, PA, 15232, USA.
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Kirks RC, Lorimer PD, Fruscione M, Cochran A, Baker EH, Iannitti DA, Vrochides D, Martinie JB. Robotic longitudinal pancreaticojejunostomy for chronic pancreatitis: Comparison of clinical outcomes and cost to the open approach. Int J Med Robot 2017; 13. [PMID: 28548233 DOI: 10.1002/rcs.1832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/06/2017] [Accepted: 04/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study compares clinical and cost outcomes of robot-assisted laparoscopic (RAL) and open longitudinal pancreaticojejunostomy (LPJ) for chronic pancreatitis. METHODS Clinical and cost data were retrospectively compared between open and RAL LPJ performed at a single center from 2008-2015. RESULTS Twenty-six patients underwent LPJ: 19 open and 7 RAL. Two robot-assisted cases converted to open were included in the open group for analysis. Patients undergoing RAL LPJ had less intraoperative blood loss, a shorter surgical length of stay, and lower medication costs. Operation supply cost was higher in the RAL group. No difference in hospitalization cost was found. CONCLUSIONS Versus the open approach, RAL LPJ performed for chronic pancreatitis shortens hospitalization and reduces medication costs; hospitalization costs are equivalent. A higher operative cost for RAL LPJ is mitigated by a shorter hospitalization. Decreased morbidity and healthcare resource economy support use of the robotic approach for LPJ when appropriate.
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Affiliation(s)
- Russell C Kirks
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Patrick D Lorimer
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael Fruscione
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Allyson Cochran
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Erin H Baker
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - David A Iannitti
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Dionisios Vrochides
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - John B Martinie
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Crisanto-Campos B, Trejo-Ávila M, Román Ramírez E, Lina-López L, Moreno-Portillo M. Total laparoscopic pancreaticojejunal anastomosis (modified Puestow procedure): A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Deie K, Uchida H, Kawashima H, Tanaka Y, Fujiogi M, Amano H, Murase N, Tainaka T. Laparoscopic side-to-side pancreaticojejunostomy for chronic pancreatitis in children. J Minim Access Surg 2016; 12:370-2. [PMID: 27251846 PMCID: PMC5022521 DOI: 10.4103/0972-9941.182655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Surgical pancreatic duct (PD) drainage for chronic pancreatitis in children is relatively rare. It is indicated in cases of recurrent pancreatitis and PD dilatation that have not responded to medical therapy and therapeutic endoscopy. We performed laparoscopic side-to-side pancreaticojejunostomy for two paediatric patients with chronic pancreatitis. The main PD was opened easily by electrocautery after locating the dilated PD by intraoperative ultrasonography. The dilated PD was split longitudinally from the pancreatic tail to the pancreatic head by laparoscopic coagulation shears or electrocautery after pancreatography. A laparoscopic side-to-side pancreaticojejunostomy was performed by a one-layered technique using continuous 4-0 polydioxanone (PDS) sutures from the pancreatic tail to the pancreatic head. There were no intraoperative or postoperative complications or recurrences. This procedure has cosmetic advantages compared with open surgery for chronic pancreatitis. Laparoscopic side-to-side pancreaticojejunostomy in children is feasible and effective for the treatment of chronic pancreatitis.
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Affiliation(s)
- Kyoichi Deie
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo; Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Michimasa Fujiogi
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naruhiko Murase
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Total laparoscopic pancreaticojejunal anastomosis (modified Puestow procedure): A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 82:97-99. [PMID: 27161791 DOI: 10.1016/j.rgmx.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/14/2015] [Accepted: 12/28/2015] [Indexed: 11/20/2022]
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Parekh D, Natarajan S. Surgical Management of Chronic Pancreatitis. Indian J Surg 2015; 77:453-69. [PMID: 26722211 DOI: 10.1007/s12262-015-1362-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022] Open
Abstract
Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.
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Affiliation(s)
- Dilip Parekh
- Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033 USA
| | - Sathima Natarajan
- Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033 USA ; Department of Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA USA
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Laparoscopic Lateral Pancreaticojejunostomy and Laparoscopic Berne Modification of Beger Procedure for the Treatment of Chronic Pancreatitis. Surg Laparosc Endosc Percutan Tech 2014; 24:e178-82. [DOI: 10.1097/sle.0b013e31829ce803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zhang JS, Li L, Liu SL, Hou WY, Diao M, Zhang J, Li SL, Ming AX, Liu Y, Wang HB, Cheng W. Laparoscopic pancreaticojejunostomy for pancreatic ductal dilatation in children. J Pediatr Surg 2012; 47:2349-52. [PMID: 23217904 DOI: 10.1016/j.jpedsurg.2012.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 07/14/2012] [Accepted: 08/04/2012] [Indexed: 01/19/2023]
Abstract
PURPOSE The application of laparoscopic surgery in pancreatic surgery in children is limited. In this article, we describe laparoscopic pancreaticojejunostomy for children with congenital pancreatic ductal dilatation. METHODS Four children with recurrent pancreatitis and pancreatic ductal dilatation underwent laparoscopic pancreaticojejunostomy between July 2009 and November 2011. Longitudinal incision of the dilated pancreatic ducts and side-to-side Roux-Y pancreaticojejunostomy were performed. RESULTS Operative time ranged from 103 to 154 min, and blood loss was minimal. The average postoperative hospital stay was 4 to 6 days. There were no pancreatic leaks. None of the patients experienced recurrence of pancreatitis. CONCLUSIONS Laparoscopic pancreaticojejunostomy for children with congenital pancreatic ductal dilatation is safe and effective.
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Affiliation(s)
- Jin-Shan Zhang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
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Abstract
Minimally invasive surgery has been widely accepted as an alternative to conventional open surgery in many gastrointestinal fields and is now considered the standard of care in bariatric surgery as well as oncologic surgery of the colon and stomach. Despite the advancements in laparoscopic surgery instrumentation and technique, the anatomic relationships of the pancreas and the need for complex reconstructions have slowed similar progress in management of pancreatic disease. However, numerous recent studies show promising results in laparoscopic management of pancreatic pseudocyst, necrosis, and benign and malignant pancreatic neoplasms. We present the current status of clinical application of minimally invasive techniques for the treatment of complicated pancreatitis, chronic pancreatitis, and pancreatic neoplasms, and provide a review of the relevant literature. Present day and probable future developments, such as the use of robotics, natural orifice techniques, and major vascular reconstruction are also presented.
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Affiliation(s)
- George Rossidis
- Hepato-Pancreatico-Biliary Surgery Service, Division of General Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Abstract
The diagnosis and treatment of patients with pancreatic strictures presents a multitude of clinical challenges. The etiology of pancreatic strictures is varied, including benign strictures subsequent to acute pancreatitis, trauma, postsurgical, post-endoscopic retrograde cholangiopancreatography (ERCP), and malignancy. Patients with strictures usually present with symptoms of recurrent pancreatitis, abdominal pain, weight loss, and/or steatorrhea. The absence of a prior history of pancreatitis or surgery increases the likelihood of malignancy. High-quality imaging studies of the pancreas, CT, MRI/magnetic resonance cholangiopancreatography, or endoscopic ultrasound (EUS) scanning are utilized for better definition. Imaging detects an associated mass and/or demonstrates the ductal anatomy. Invasive procedures such as ERCP are performed to better define the causal relationships of the patient's symptoms or to obtain tissue diagnosis. Treatment goals include ameliorating symptoms, dilating the stricture, and ruling out cancer. The risk of malignancy underlies much of the intervention, which includes serology, cytologic analysis, and serial imaging. EUS has become the procedure of choice to rule out a mass, to evaluate the parenchyma for evidence of chronic pancreatitis, and to obtain fine-needle biopsies for tissue confirmation. In symptomatic patients or patients with indeterminate strictures, ERCP is used for direct pancreatography, tissue acquisition, and endoscopic treatment. Endotherapy includes sphincterotomy, dilation, and stenting to provide drainage. We view ERCP as the optimal first-line treatment modality. ERCP offers the potential of curative treatment and is less invasive than surgery, especially as some patients' symptoms are not severe enough to justify surgery. If patients do not experience relief of symptoms after several sessions of endoscopic therapy, surgery is the logical next step for definitive, long-term treatment.
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Meehan JJ, Sawin R. Robotic lateral pancreaticojejunostomy (Puestow). J Pediatr Surg 2011; 46:e5-8. [PMID: 21683190 DOI: 10.1016/j.jpedsurg.2011.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/28/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
A lateral pancreaticojejunostomy (LPJ), also known as the Puestow procedure, is a complex procedure performed for chronic pancreatitis when the pancreatic duct is dilated and unable to drain properly. Traditionally, these procedures are performed with open surgery. A minimally invasive approach to the LPJ using rigid handheld nonarticulating instruments is tedious and rarely performed. In fact, there are no prior laparoscopic case reports for LPJ in children and only a small handful of cases in the adult literature. This lack of laparoscopic information may be an indication of the difficulty in performing this complex operation with nonarticulating laparoscopic instruments. The advantages of robotic surgery may help overcome these difficulties. We present the first robotic LPJ ever reported in a 14-year-old child with idiopathic chronic pancreatitis. This case demonstrates the utility of this advanced surgical technology and may lead to a new minimally invasive option for both adults and children with chronic pancreatitis requiring surgical intervention.
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Affiliation(s)
- John J Meehan
- Seattle Children's Hospital, Seattle, WA 98105, USA.
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Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy. Surg Endosc 2010; 25:1101-6. [PMID: 20835724 DOI: 10.1007/s00464-010-1324-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 08/09/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Benign and borderline malignant pancreatic tumors are increasing. Function-preserving and minimally invasive pancreatectomy may be an ideal approach for these tumors. METHODS The authors retrospectively evaluated their initial experiences with five consecutive robotic central pancreatectomies (CPs). They also compared the perioperative outcome for open CPs performed in their institution. RESULTS The five women in the study had a median age of 45 years (range 36-64 years). A solid pseudopapillary tumor of the pancreas was found in four patients, and a pancreatic endocrine tumor was found in one patient. The tumor was relatively small (median size, 1.5 cm; range, 1-2 cm). All remnant pancreases were managed using pancreaticogastrostomy. The median operation time was 480 min (range 360-480 min), and the median estimated intraoperative bleeding was 200 ml (range 100-600 ml). No transfusion was given during the perioperative period. The median hospital stay was 12 days (range 9-28 days). Only one patient experienced postoperative pancreatic fistula (grade B), which was managed using the percutaneous drainage procedure. No operative morality was noted. In a comparative analysis with open CP, the robotic CP group demonstrated a smaller asymptomatic (17 out of 10 patients vs none, p = 0.026) tumor (5.9 ± 6.4 vs 1.4 ± 0.4 cm; p = 0.055), a longer operation time (286.5 ± 90.2 vs 432.0 ± 65.7 min, p = 0.013), and less intraoperative bleeding (432.0 ± 65.7 vs 286.5 ± 90.2 ml, p = 0.013). CONCLUSION Central pancreatectomy can be selected carefully as an appropriate surgical option for benign and borderline malignant lesions limited to the pancreatic neck area. The robotic surgical system may allow surgeons to perform complex and difficult laparoscopic procedures more easily, effectively, and precisely.
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Internal Pancreatic Fistulae - Management Review. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee KK, Chen D, Hughes SJ. Minimally invasive treatment of pancreatic disease. Gastroenterol Clin North Am 2007; 36:441-54, xi. [PMID: 17533089 DOI: 10.1016/j.gtc.2007.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although open surgical procedures remain the standard for both benign and malignant diseases of the pancreas, in recent years a wide variety of surgical procedures performed on the pancreas have been completed laparoscopically. This article reviews the application of minimally invasive surgery to the management of both benign and malignant diseases of the pancreas.
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Affiliation(s)
- Kenneth K Lee
- Section of Gastrointestinal Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 497 Scaife Hall, 3550 Lothrop Street, Pittsburgh, PA 15261, USA.
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