The Minimally Invasive Approach to Surgical Management of Pancreatic Diseases

Laparoscopic surgery offers several significant advantages over open surgery, including more rapid recovery, lower wound complication rates, shorter hospital stay with its associated cost savings, and avoidance of large, chevron-type incisions typically required for open pancreatic surgery with their significant long-term morbidity. The acceptance and widespread utilization of laparoscopic techniques in pancreatic surgery, however, has had a slow evolution for several reasons, including substantial technical challenges, the risk of serious complications because of the proximity of the pancreas to major vascular structures, and the need for skills in both advanced laparoscopic surgery and expertise in open pancreatic surgery. Since the first reported case of laparoscopic distal pancreatectomy, case studies and series have been accumulating in the literature describing the laparoscopic treatment of pancreatic diseases such as pancreatic necrosis, chronic pancreatitis, and benign and malignant pancreatic tumors. Fig. 1 shows the different surgical procedures on the pancreas. In this review, the focus is on the results of the laparoscopic procedures that have gained more widespread acceptance, such as left-sided pancreatic resections, enucleation of pancreatic tumors, pancreatic debridement, and pancreaticoduodenectomy for pancreatic head lesions.