Introduction: The conventional approach for most pancreatic neoplasms is to perform formal anatomic resections, which is technically challenging and carries a high morbidity and mortality rate. Minimally invasive surgery (MIS) enucleation has been proposed for cases of benign and low-grade pancreatic lesions and is an atypical, parenchymal sparing procedure which shells out the lesion while preserving the surrounding tissue. Methods: Adequate preoperative planning is essential for the success of either MIS or open surgery. It includes standard labs with PNET hormones, preoperative optimization, imaging (pancreatic protocol CT or MRI, Octreoscan, DOTATATE PET/CT, or EUS) for mapping and its relationship to other major structures and a diagnostic laparoscopy prior to enucleation or surgical resection. Result: The use of MIS requires few small incisions when compared to open resection resulting in shorter hospital stay, faster recovery time, and overall comparable result as surgical resection. The DaVinci Robot system even allows a more precise dissection due to the greater degree of movement and reduces surgeon fatigue during long procedures when compared to conventional laparoscopic procedures. Postoperatively, MIS approach may have higher rate of fistula formation and may be due to limitations of tactile sense and inexperience. When performed in a high volume center, the overall outcome of fistula management is similar in both approaches. Conclusion: Overall, MIS is a safe and feasible technique that provides advantages over anatomical resections due to lower complication rate, higher parenchymal preservation, shorter hospital stay, and lower cost of treatment with similar outcomes and for mostly small and benign tumors.

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Enucleation

  • Luca Milone,
  • Mei Zhen Cao,
  • Andrew Gumbs,
  • Romulo Genato

摘要

Introduction: The conventional approach for most pancreatic neoplasms is to perform formal anatomic resections, which is technically challenging and carries a high morbidity and mortality rate. Minimally invasive surgery (MIS) enucleation has been proposed for cases of benign and low-grade pancreatic lesions and is an atypical, parenchymal sparing procedure which shells out the lesion while preserving the surrounding tissue. Methods: Adequate preoperative planning is essential for the success of either MIS or open surgery. It includes standard labs with PNET hormones, preoperative optimization, imaging (pancreatic protocol CT or MRI, Octreoscan, DOTATATE PET/CT, or EUS) for mapping and its relationship to other major structures and a diagnostic laparoscopy prior to enucleation or surgical resection. Result: The use of MIS requires few small incisions when compared to open resection resulting in shorter hospital stay, faster recovery time, and overall comparable result as surgical resection. The DaVinci Robot system even allows a more precise dissection due to the greater degree of movement and reduces surgeon fatigue during long procedures when compared to conventional laparoscopic procedures. Postoperatively, MIS approach may have higher rate of fistula formation and may be due to limitations of tactile sense and inexperience. When performed in a high volume center, the overall outcome of fistula management is similar in both approaches. Conclusion: Overall, MIS is a safe and feasible technique that provides advantages over anatomical resections due to lower complication rate, higher parenchymal preservation, shorter hospital stay, and lower cost of treatment with similar outcomes and for mostly small and benign tumors.