Laparoendoscopic single-site and robotic distal pancreatectomy

Ippei Matsumoto
2018 Laparoscopic Surgery  
Distal pancreatectomy (DP) is a standard procedure for neoplastic or inflammatory lesions in the body and tail of the pancreas. With the recent development and improvement of laparoscopic techniques and increasing surgical experience, laparoscopic surgery has been widely performed. Although the laparoscopic pancreatic surgery was introduced later when comparing to other organs, laparoscopic DP is the most widely used because of its acceptable technical feasibility and safety without complex
more » ... without complex anastomoses or reconstructions. The first report of laparoscopic DP was published by Cuschieri et al. (1) in 1996. They reported five cases of laparoscopic DP with splenectomy for chronic pancreatitis. Recent metaanalyses have shown the superiority of laparoscopic DP comparing to open DP in terms of intraoperative blood loss, patient recovery, and hospital stays with comparable morbidity rates (2-4). Although no randomized trial performed in comparing laparoscopic and open DP, laparoscopic DP has been regarded as the gold standard for at least benign and low-grade malignant tumors in comparison with the open procedures. Currently, there are several topics and issues to be clarified the real effectiveness of laparoscopic DP, including spleen preservation or not, application for pancreatic cancer, laparoendoscopic single-site surgery (LESS), and robotic surgery. The article summarizes and focus on the topics of LESS and robotic DP. Robotic surgery emerged at the end of the last century. One of the most advantages of robotic systems could be the reproduction of the movement of the hand and fingers with seven degrees of freedom just as open surgery. Robotic surgery may have potential benefits to reduce the rate of conversion to laparotomy when comparing to laparoscopic surgery. The first robotic laparoscopic DP was described by Melvin et al. (5) in 2003. At present, however, most studies of robotic pancreatic surgery are still limited with singleinstitution, surgeon case series of small numbers. There have been reported three meta-analyses on the safety of robotic versus laparoscopic DP (6-8). The data revealed that there were no differences between the two techniques in terms of the rate of postoperative pancreatic fistula, morbidity, and conversion to open surgery. Zhou et al. (6) reported a meta-analysis of robotic versus laparoscopic DP when they showed significant advantages in intraoperative blood loss, length of hospital-stay, and spleen preservation rate. Gavriilidis et al. (7) also reported shorter hospital stay in robotic DP in their meta-analysis, but higher readmission rate. Definitive conclusions on the actual role of robotic DP have not been drawn because there is no randomized trial comparing with robotic and laparoscopic DP. Recently, to develop further minimally invasive surgery by reducing numbers and sizes of the ports, many experienced laparoscopic surgeons have tried to perform new technique. Potential benefits of the minimization of skin incision include cosmesis, less pain, early recovery, and lower rate of port-related complication. Since the first LESS was attempted at laparoscopic cholecystectomy in 2010, LESS has been successfully and widely applied for many abdominal surgeries (9-11). As most patients with cystic or solid and benign tumors of the pancreas are young females, demand for laparoscopic DP to eradicate the tumor and minimize the cosmetic impact of the surgical wound is increased. However, reports of LESS in DP are rather Editorial
doi:10.21037/ls.2018.04.03 fatcat:x6g66pdzerhfndg4nswokcpmbm