Pancreas: what is the role of minimally invasive surgery?

Advances in minimally invasive surgical technique, technology, and instrumentation have fostered the application of minimally invasive surgery to the management of pancreatic malignancies. Procedures such as laparoscopic staging and laparoscopic distal pancreatectomies that do not require complex reconstructions are feasible, safe, and appear to offer significant benefits in comparison to the comparable open procedures. Moreover, they can be taught to surgical trainees and can be readily disseminated beyond specialized centers. In contrast, more complex procedures such as laparoscopic pancreaticoduodenectomy or central pancreatectomy have been safely performed in specialized centers, but their usefulness in comparison to open procedures remains to be defined. As laparoscopic skills and technology continue to improve, however, it is likely that such complex procedures will be performed with greater frequency. Future trials that confirm the safety and benefits of these advanced laparoscopic procedures in comparison to open procedures are therefore of paramount importance. Additionally, studies that specifically evaluate and compare the oncologic outcomes of laparoscopic and open pancreatic resections are needed.