Minimally Invasive Approaches in Pancreatic Surgery

2018 ◽  
Author(s):  
Waseem Lutfi ◽  
Melissa E Hogg
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Surgery ◽  
Standard Of Care ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Short Term ◽  
Pancreatic Resections ◽  
Key Words Clinical Trials ◽  
Minimally Invasive Pancreatic Surgery

Minimally invasive approaches for pancreatic resections are being increasingly utilized at highly specialized centers. Both laparoscopic and robotic techniques appear to be associated with improved short-term outcomes such as decreased morbidity and shorter hospital stay. However, there are still concerns with regards to cost-effectiveness and technical training, which have prevented widespread dissemination of these techniques. For pancreatic surgery, both laparoscopic and robotic techniques have gained acceptance for all pancreatic resections, most notably in distal pancreatectomy where minimally invasive approaches have become the standard of care at high-volume centers. This chapter discusses the preoperative considerations and operative techniques of minimally invasive pancreatic surgery while also reviewing the current literature detailing short-term and long-term outcomes. This review contains 46 references, 6 figures, 5 tables, and 2 videos. Key Words: clinical trials, laparoscopic, minimally invasive, morbidity, mortality, oncologic outcomes, open, pancreatic cancer, robot-assisted

Minimally Invasive Approaches in Liver Surgery

2018 ◽  
Author(s):  
Waseem Lutfi ◽  
Melissa E Hogg
Keyword(s):  
Minimally Invasive ◽  
Liver Surgery ◽  
Oncologic Outcomes ◽  
Operative Techniques ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Key Words Clinical Trials ◽  
Widespread Dissemination

Minimally invasive approaches for liver surgery are being increasingly used at highly specialized centers. Both laparoscopic and robotic techniques appear to be associated with improved short-term outcomes such as decreased morbidity and shorter hospital stay. However, there are still concerns with regard to cost-effectiveness and technical training that have prevented widespread dissemination of these techniques. Within the realm of liver surgery, laparoscopic approaches have gained acceptance; however, robotic surgery still remains a relatively new technique. This chapter discusses the preoperative considerations and operative techniques of minimally invasive liver surgery, while also reviewing the current literature detailing short-term and long-term outcomes. This review contains 6 figures, 5 tables and 33 references Key Words: clinical trials, laparoscopic, liver cancer, minimally invasive, morbidity, mortality, oncologic outcomes, open, robot-assisted,

scholarly journals Centralization of Pancreatic Surgery Improves Results: Review

2020 ◽  
Vol 109 (1) ◽  
pp. 4-10 ◽  
Author(s):  
R. Ahola ◽  
J. Sand ◽  
J. Laukkarinen
Keyword(s):  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Optimal Operation ◽  
Failure To Rescue ◽  
Short Term ◽  
Pancreatic Resections ◽  
The World ◽  
Low Volume ◽  
Active Research

Background and Aims: The effect of operation volume on the outcomes of pancreatic surgery has been a subject of research since the 1990s. In several countries around the world, this has led to the centralization of pancreatic surgery. However, controversy persists as to the benefits of centralization and what the optimal operation volume for pancreatic surgery actually is. This review summarizes the data on the effect of centralization on mortality, complications, hospital facilities used, and costs regarding pancreatic surgery. Materials and Methods: A systematic librarian-assisted search was performed in PubMed covering the years from August 1999 to August 2019. All studies comparing results of open pancreatic resections from high- and low-volume centers were included. In total 44, published articles were analyzed. Results: Studies used a variety of different criteria for high-volume and low-volume centers, which hampers the evaluating of the effect of operation volume. However, mortality in high-volume centers is consistently reported to be lower than in low-volume centers. In addition, failure to rescue critically ill patients is more common in low-volume centers. Cost-effectiveness has also been evaluated in the literature. Length of hospital stay in particular has been reported to be shorter in high-volume centers than in low-volume centers. Conclusion: The effect of centralization on the outcomes of pancreatic surgery has been under active research and the beneficial effect of it is associated especially with better short-term prognosis after surgery.

Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers

2019 ◽  
Vol 270 (6) ◽  
pp. 1147-1155 ◽  
Author(s):  
Robert J. Torphy ◽  
Chloe Friedman ◽  
Alison Halpern ◽  
Brandon C. Chapman ◽  
Steven S. Ahrendt ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Short Term ◽  
Open Pancreaticoduodenectomy

scholarly journals Minimally invasive pancreatic surgery—will robotic surgery be the future?

2021 ◽  
Author(s):  
Luca Dittrich ◽  
Matthias Biebl ◽  
Thomas Malinka ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Surgery ◽  
Pancreatic Head ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Current Evidence ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Pancreas Head ◽  
Minimally Invasive Pancreatic Surgery

SummaryDue to the complexity of the procedures and the texture of the organ itself, pancreatic surgery remains a challenge in the field of visceral surgery. During the past decade, a minimally invasive approach to pancreatic surgery has gained distribution in clinical routine, extending from left-sided procedures to pancreatic head resections. While a laparoscopic approach has proven beneficial for many patients with left-sided pancreatic pathologies, the complex reconstruction in pancreas head resections remains worrisome with the laparoscopic approach. The robotic technique was established to overcome such technical constraints while preserving the advantages of the laparoscopic approach. Even though robotic systems are still in development, especially in pancreatoduodenectomy, the current literature demonstrates the feasibility of this approach and stable clinical and oncological outcomes compared to the open technique, albeit only under the condition of such operations being performed by specialist teams in a high-volume setting (>20 robotic pancreaticoduodenectomies per year). The aim of this review is to analyze the current evidence regarding a minimally invasive approach to pancreatic surgery and to review the potential of a robotic approach. Presently, there is still a scarcity of sound evidence and long-term oncological data regarding the role of minimally invasive and robotic pancreatic surgery in the literature, especially in the setting of pancreaticoduodenectomy.

scholarly journals Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirhasan Rahimli ◽  
Aristotelis Perrakis ◽  
Vera Schellerer ◽  
Andrew Gumbs ◽  
Eric Lorenz ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

scholarly journals The European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS): First Year Experience

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S66-S67
Author(s):  
N. van der Heijde ◽  
F. Vissers ◽  
F. Can ◽  
T. Hackert ◽  
I. Khatkov ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Surgery ◽  
First Year Experience ◽  
First Year ◽  
Minimally Invasive Pancreatic Surgery ◽  
European Registry

scholarly journals Pancreatic Resections in Renal Failure Patients: Is It Worth the Risk?

HPB Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
K. S. Norman ◽  
S. R. Domingo ◽  
L. L. Wong
Keyword(s):  
Renal Failure ◽  
Pancreatic Surgery ◽  
Case Reports ◽  
Case Series ◽  
Cardiovascular Complications ◽  
Improvement Program ◽  
Term Survival ◽  
Pancreatic Resections ◽  
American College Of Surgeons

Background. Chronic kidney disease affects 20 million US patients, with nearly 600,000 on dialysis. Long-term survival is limited and the risk of complex pancreatic surgery in this group is questionable. Previous studies are limited to case reports and small case series and a large database may help determine the true risk of pancreatic surgery in this population. Methods. The American College of Surgeons National Surgical Quality Improvement Program database was queried (2005–2011) for patients who underwent pancreatic resection. Renal failure was defined as the clinical condition associated with rapid, steadily increasing azotemia (rise in BUN) and increasing creatinine above 3 mg/dL. Operative trends and short-term outcomes were reviewed for those with and without renal failure (RF). Results. In 18,533 patients, 28 had RF. There was no difference in wound infections, neurologic or cardiovascular complications. Compared to non-RF patients, those with RF had more unplanned intubation (OR 4.89, 95% CI 1.85–12.89), bleeding requiring transfusion (OR 3.12, 95% CI 1.37–14.21), septic shock (OR 8.86, 95% CI 3.75–20.91), higher 30-day mortality (21.4% versus 2.3%, P<0.001) and longer hospital stay (23 versus 12 days, P<0.001). Conclusions. RF patients have much higher morbidity and mortality after pancreatic resections and surgeons should consider this before proceeding.

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