Laparoscopic pancreatic surgery in a single setting

Received: 10-Mar-2022, Manuscript No. PULJEDS-22-4634; Editor assigned: 12-Mar-2022, Pre QC No. PULJEDS-22-4634(PQ); Accepted Date: Apr 01, 2022; Reviewed: 20-Mar-2022 QC No. PULJEDS-22-4634(Q); Revised: 22-Mar-2022, Manuscript No. PULJEDS-22-4634(R); Published: 07-Apr-2022, DOI: 10.37532/puljeds.22.6(2).08 -09

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Abstract

Over the last decade, laparoscopic surgery for benign and malignant pancreatic tumours has progressively gained favour and is now being used in many centres. Some studies show that this method is as good as or better than open surgery, although randomised data is needed to determine the outcome. By pooling high-quality published material, we want to give a thorough review of the state of the art in laparoscopic pancreatic surgery in this Review. The benefits, restrictions, oncological effectiveness, learning curve, and most recent advancements are all highlighted. Although the focus is on the laparoscopic Whipple technique and laparoscopic distal pancreatectomy for both benign and malignant illness, robot-assisted surgery is also discussed. Surgical and oncological results, as well as quality of life and cost-effectiveness of laparoscopic pancreatic surgery, are examined. We've also added decision-aid algorithms based on research and our own experience, which might help you decide whether to have a laparoscopic or open operation. Solid malignancies of the kidney, colon, adrenal glands, and prostate are now regularly treated via laparoscopic (lap) organ resection. Because of the operational intricacy and potential for complications, surgeons have been cautious to embrace minimally invasive methods to the pancreas. The vast majority of available papers on lap pancreatectomy are single-center research with fewer than 20 patients described. Larger cases proving the safety and effectiveness of lap tumour enucleation and lap left pancreatectomy have just recently appeared. Understanding the impact of the lap approach to pancreatectomy on cancer prognosis is critical since neoplastic illness is the most prevalent reason for pancreatic resection. Adequacy of resection as determined by margin status and nodal evaluation must be examined in addition to concerns about port-site tumour recurrence and tumour spread owing to lap manipulation in the presence of pneumoperitoneum. The development and current state-of-the-art of lap pancreatic surgery for cancer are discussed in this study. Existing data on open and lap pancreatic resections is reviewed, with a focus on pancreatic ductal adenocarcinoma. Future advancements in the field of lap pancreatic surgery are expected.

Keywords

Pancreatectomy; Pneumoperitoneum; Pancreatic resections

Introduction

In 1992, the first laparoscopic resections for pancreatic neoplasms were performed. Throughout the next decade, it was frequently demonstrated that laparoscopic resections of pancreatic neoplasms were practical, safe, and could be conducted with appropriate resection margins2–7. In terms of short-term outcomes, laparoscopy has been found to be superior to open distal pancreatectomy. To far, the majority of investigations have been single-institution series with small patient populations, mainly involving resections of minor or benign lesions. The role of laparoscopic resections for malignant neoplasms is still up for discussion. In 1997, laparoscopic surgery for lesions in the body and tail of the pancreas was established at Rikshospitalet University Hospital, a tertiary referral hospital. Regardless of size or suspected underlying disease, laparoscopic resection has become the preferred approach for removing lesions in the body and tail of the pancreas. The goal of this study was to look at the safety and feasibility of laparoscopic pancreatic surgery with the goal of curing pancreatitis, as well as to report short-term outcomes in a non-selected patient group. OVER THE LAST TWO DECADES, a significant improvement in prognosis for critically sick patients with necrotizing pancreatitis has been recorded. Death rates of more than 50%, which were frequent in the 1970s, have recently reduced to less than 20% (and even single digits in several specialist pancreatic surgery departments).

A number of variables have led to the significant decrease in acute necrotizing pancreatitis mortality. The availability of critical care educated physicians and developments in critical care have significantly reduced early mortality from hemodynamic insufficiency and systemic inflammatory response syndrome (SIRS). Advances in interventional radiological methods have made it possible to avoid or delay surgical intervention. Surgery has been used seldom thanks to a multidisciplinary team approach (surgery, radiology, gastrointestinal, and critical care). The surgical method for pancreatic necrosectomy (removal of a sequestrum of clearly recognisable necrotic tissue that can be readily separated from surrounding healthy tissue during surgery) has been standardised. Furthermore, it is now known that the best surgical scheduling is 2 to 3 weeks following the beginning of pancreatitis to allow a sequestrum to develop, avoiding the significant morbidity and mortality associated with early pancreatic resections.

THE TUMOR'S LOCALIZATION

Imaging methods are utilised to confirm and pinpoint the existence of a single or many insulinomas if abnormally high insulin levels are detected. Because the position of the insulinoma in the pancreas, its number, and its proximity to significant anatomical structures are the most important factors of the surgical approach chosen, preoperative localization of the insulinoma is critical in the management of these neoplasms. When a tumour could not be detected and/or palpated intraoperatively, blind distal pancreatectomy was the conventional surgical approach. Blind resections for tiny and benign insulinomas are no longer necessary because to better localisation methods. Insulinomas are normally benign, and most patients stay disease-free after surgical excision, even after a lengthy period of follow-up. As a result of the accompanying perioperative and postoperative morbidity and mortality, large pancreatic resections are not currently suggested in these settings. There are now several invasive and non-invasive imaging modalities accessible, and the choice of imaging test is mostly based on local expertise, availability, and patient desire. Imaging scans reveal important details about the tumor's location, the amount of local invasion, and the existence of metastatic lesions. Invasive and non-invasive tests for preoperative insulinoma localization, as well as laparoscopic ultrasonography for intraoperative localization, are among the imaging investigations. Spiral computed tomography (CT), magnetic resonance imaging (MRI), transabdominal ultrasonography (US), pentetreotide scintigraphy, and positron emission tomography (PET) using fluorine-18-L-dihydroxyphenylalanine are examples of non-invasive testing. Because of its ubiquitous availability, cheap cost compared to other methods, lack of radiation exposure, patient compliance, and ability to examine suspected abdominal metastases, a transabdominal ultrasound is often the first test used. The reliance on operator skill, difficulty assessing intra-abdominal structures in the obese patient, and decreased sensitivity with small diameter lesions (less than 2 cm) and tumours placed in the tail of the pancreas are all major disadvantages. 16,17 However, detection by contrast-enhanced transabdominal US has been found to be equivalent to detection by conventional CT in several high-volume sites. The most frequent non-invasive preoperative localization test is computed tomography (CT). Insulinomas are often observed as spherical, well-defined lesions with contrast enhancement. Previous large-scale studies examining CT sensitivity in the identification of insulinomas gave mediocre findings (around 70%). However, advances in CT technology have significantly altered its use as a first-line choice in preoperative detection, and past modest results are unlikely to reflect the present state of the technology. Due to its capacity to better detect tiny lesions and hence increase sensitivity to over 80%, dynamic CT has overtaken traditional CT scanning as the modality of choice. 21 Large-scale single-institution research have shown that adopting newer CT methods improves sensitivity significantly. Better visibility of the abdominal cavity to rule out metastases or concomitant abdominal disease, as well as less subjective interpretation of imaging data, are two further advantages of CT over transabdominal US. Surgeons who are familiar with abdominal CT scans can better visualise tumour localisation, allowing for better preoperative planning. Radiation exposure and, in a tiny minority of vulnerable individuals, severe and even life-threatening allergic responses to the contrast media are obvious disadvantages.