Laparoscopic Pancreatic Resection without Advanced Laparoscopic Devices

Background/Aims: Laparoscopic pancreatic resection has been slow to develop because of the high degree of technical difficulty and generally expensive laparoscopic devices required. We evaluate our experience with laparoscopic resections for pancreatic pathologies without expensive and advanced laparoscopic devices. Methodology: A prospective evaluation was carried out of consecutive laparoscopic pancreatic resections performed between July 2003-June 2011. Results: Laparoscopic pancreatic resections were attempted in 13 and performed in 10 patients: 6 laparoscopic spleen-preserving distal pancreatectomy and 4 laparoscopic enucleation. Pathological diagnoses: four insulinomas, two serous cystadenoma, two pancreatic pseudocyst, one microcystic serous cystadenoma, two non-functioning neuroendocrine tumors, one leiomyosarcoma, and one case of solid-pseudopapillary tumor. In the laparoscopic operations the mean operative time was 195min and no blood transfusions were required. The mean postoperative hospital stay was 4.7 days. There were three pancreatic fistulas. No patients required a second operation. There were no deaths. Follow-up was available for all patients. Conclusions: Laparoscopic pancreatic resection is feasible and relatively safe without advanced laparoscopic devices. As with open resections, pancreatic fistula is the dominant morbidity. The best indications for a laparoscopic approach are benign pancreatic tumors that are not inside the neck of the pancreas and do not require pancreaticoenteric reconstruction.