Laparoscopic Pancreatectomy: Road to Its Standardization

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  • Nakamura Yoshiharu
    Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
  • Uchida Eiji
    Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School

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  • 腹腔鏡下膵切除術の標準化に向けた取り組み
  • フククウキョウ カスイセツジョジュツ ノ ヒョウジュンカ ニ ムケタ トリクミ

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Abstract

Laparoscopy allows 10 to 15 times greater magnification of intra-abdominal tissues, organs, and vessels than an open approach. Laparoscopic surgery also improves visualization of the intra-abdominal organs for all surgeons involved in the operation, especially of the retroperitoneal organs, including the pancreas, neighboring vessels, duodenum, adrenal gland, and kidney. In this respect, laparoscopic pancreatic surgery is obviously superior to an open approach, where the ribs and organs anterior to the pancreas obstruct the operative field. Improved visualization also enables precise dissection using forceps. With regard to laparoscopic surgery for pancreatico-biliary malignancies, it is especially important to create a good operative field when dissecting the lymph nodes and pancreatic nerve plexuses where cancer cells easily infiltrate, and to perform R0 resection, which increases long-term survival in patients with pancreatico-biliary malignancies. Additionally, laparoscopic surgery is very useful in educating future healthcare professionals, because it provides the same visual field to all surgeons involved in the operation. The disadvantages of laparoscopic surgery over an open approach include the limited range of motion and the limited sense of touch, because laparoscopy is performed using a number of forceps inserted through trocars. Endoscopic surgeons must determine the most appropriate operative method for each patient, assessing whether laparoscopic pancreatectomy is suitable or not through a full understanding of the advantages and disadvantages of laparoscopic procedures. To date, we have performed laparoscopic pancreatectomies in more than 200 patients. The objective of this overview is to provide a better understanding of how far laparoscopic pancreatectomy has been standardized, based on our major experiences and a review of the literature.

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