Hand-assisted laparoscopic total pancreatectomy: a report of two cases

Because of improvement in surgical technique and endocrine and exocrine insufficiency management, total pancreatectomy is being frequently performed, especially for benign or low-potential malignant diseases. The laparoscopic approach is rarely performed.

Our aim is to report two cases operated by the assisted laparoscopic approach and to describe a standardized surgical technique.

Two patients underwent laparoscopic total pancreatectomy with assisted minilaparotomy or the hand-assisted technique for degenerated intraductal papillary mucinous neoplasms (IPMNs) and neuroendocrine tumors with operative times of 270 and 360 minutes, estimated blood loss of 200 and 300 mL, and a hospital stay of 12 and 18 days, respectively. One patient was re-operated on postoperative Day 10 for bleeding from the hepaticojejunostomy probably related to an inadequate dose of antiproton inhibitors, necessitating refection of the anastomosis with an uneventful course. Pathological examination revealed degenerated IPMNs (T3N1R0) and well-differentiated neuroendocrine tumors (T2NOR0) with complete resection. After 6-10 months of follow-up, the diabetes is well controlled with insignificant episodes of hypoglycemia in 1 patient without any evidence of tumor relapse.

In selected patients laparoscopic total pancreatectomy appears safe and had many advantages over the open and other laparoscopic pancreatic resection approaches, including first laparoscopic abdominal exploration and no pancreatic anastomosis. Oncological rules can be respected, but further larger studies are needed before drawing conclusions.