Laparoscopic Pancreatic Resections

Resection of the pancreas by the laparoscopic approach is still in its infancy and the reported experience is very limited. Despite its retroperitoneal location, exposure and mobilisation of the pancreas can be achieved in the vast majority of patients and does not usually pose major technical problems provided the surgeon is experienced in advanced laparoscopic techniques and in pancreatic surgery. Based on our experience, laparoscopic enucleation of islet-cell tumours constitutes an ideal indication. Both the precise location (by contact ultrasonography of the pancreas) and the enucleation (by ultrasonic dissection) are facilitated by the laparoscopic approach. Laparoscopic distal 70-80% pancreatectomy for chronic pancreatitis and cystic tumors appears to confer benefit over the equivalent open operation by accelerating recovery and return to full activity of the patient after surgery. By contrast, our experience with laparoscopic pancreaticoduodenectomy for periampullary cancer has been disappointing and we have not documented any benefit from this approach. In addition, there are real concerns that an oncologically adequate operation (with extended lymphadenectomy) for cancer of the head of the pancreas is not possible by the laparoscopic approach.