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Laparoscopic total pancreatectomy (LTP) is technical challenging and rarely reported in the literature. Herein, we introduced a safe and feasible approach to perform LTP basing on our own experience.Over the period of July 2015 to August 2018, we performed 13 cases of LTP at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected. The surgical procedures were also described in this study.Seven male and six female patients were included in this study. The median age of the patients was 51 years (range 29-79 years). The median operative time was 355 minutes (range 300-470 minutes). The median estimated blood loss was 200 mL (range 50-1000 mL). The median postoperative hospital stay was 17 days (range 12-23 days). One patient suffered from bile leakage and another patient suffered from delayed gastric emptying. Both patients cured with conservative therapy.Laparoscopic total pancreatectomy can be safely and feasibly performed in well-selected patients.

Compared with traditional surgery, minimally invasive surgery has the advantages of less complications and quick postoperative recovery. Therefore, modern surgery is developing towards the direction of minimally invasive. while minimally invasive pancreatic surgeries are rather challenging and develop slowly, due to the limits with different operation techniques, long operation time and different operation outcomes, which are only carried out in high-volume pancreatic surgery centers. This special coverage topic will elaborate our long-term experience and the key points to overcome the operational difficulties in laparoscopic and robotic pancreas surgery. In order to promote the development of minimally invasive pancreatic technology and benefit more patients (especially pancreatic cancer patients), some suggestions and prospects with the latest research results at home and abroad are put forward for the future development of this field., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Objective: To present our institutional experience in laparoscopic spleen-preserving distal pancreatectomy (Lap-SPDP) using Kimura technique with or without early occlusion of the root of the splenic artery. In addition, to explore the safety and feasibility of this occlusion technique, especially its advantages in intraoperative hemorrhage control and spleen preservation., Methods: From February 2011 to May 2019, 54 consecutive patients who were diagnosed as benign or low-grade malignant space-occupying lesions at the body and the tail of pancreas underwent Lap-SPDP using Kimura technique in our institution. Twenty-five patients before 2015 were allocated into non-occlusion group and 29 patients after 2015 were allocated into occlusion group. The non-occlusion group underwent direct dissection of the distal pancreas with blood supply from the splenic artery as well as traditional traction of the splenic artery without occlusion. Whereas the occlusion group underwent temporary occlusion of the root of the splenic artery by Bulldog clip after transecting the neck of the pancreas and distal pancreas was excised under a relatively bloodless situation. Surgical techniques were described in detail. Data between groups were retrospectively collected and stratification analysis was performed based on the diameter of tumor (>3 cm or ≤3 cm)., Results: Before stratification, there was a statistical difference in age between the two groups ( P =0.033), but no difference in body mass index (BMI) ( P =0.069). The median lesion diameter of the two groups was 2.5 cm and 4 cm, respectively, with no statistical difference ( P =0.065). The success rates of spleen preservation in the two groups were 93.1% and 92% respectively, showing no significant difference ( P =1.000). The length of hospital stay was slightly longer in the non-occlusion group than that in the occlusion group ( P =0.020). Comparing with the non-occlusion group, the occlusion group had significantly shorter operation time (median, 165 min vs. 235 min) and less estimated blood loss (median, 100 mL vs. 200 mL) ( P <0.05). After stratification by the tumor diameter, there were 2 cases of failed spleen preservation both in occlusion and non-occlusion group with tumor diameter >3 cm (occlusion group: 2/8, 25% and non-occlusion group: 2/14,14.3%). However there was no statistical difference between the two groups ( P =0.602). When the tumor diameter ≤3 cm, the spleen preservation rate of both groups reached 100%. When the tumor diameter was >3 cm, the operation time of the occlusion group was shorter than that of the non-occlusion group ( P =0.005). In terms of intraoperative blood loss, regardless of tumor size, the occlusion group had less estimated blood loss than that of the non-occlusion group ( P <0.05). In the occlusion group, no conversion or blood transfusion was needed intraoperatively and/or postoperatively. After stratification, there was no difference in the length of hospital stay between two groups ( P >0.05). During the follow-up period (median (Min-Max), 13.5 (3-96) months), no perioperative death, disease recurrence, portal vein or splenic vein thrombosis, gastric varices or upper gastrointestinal bleeding was noted., Conclusion: Lap-SPDP using Kimura technique with early occlusion of the root of splenic artery was safe and feasible and could be generally applied. By using this technique, we could reduce the operation time and blood loss, as well as sustain a high probability of spleen preservation., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

For benign and borderline tumors in the pancreatic neck and proximal body, laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic central pancreatectomy (LCP) are alternative surgical procedures. Choosing between LSPDP and LCP is difficult. This retrospective cohort study was looking forward to provide evidence for clinical decision.A total of 59 patients undergoing LSPDP (Kimura procedure) and LCP between June 2013 and March 2017 were selected. The clinical outcomes of patients were compared by χ test or Fisher exact test and Student t test.This study included 36 patients in LSPDP group, and 23 patients in LCP group. The overall complications incidence in LCP group was significantly higher than LSPDP group (35 vs 6%, P = .004), and the postoperative pancreatic fistula (POPF) (grade B and C) rate and abdominal infection rate in LCP group were still significantly higher than LSPDP group (POPF 22 vs 3%, P = .019; abdominal infection 35 vs 3%, P = .001, respectively). The length of resected pancreas was significantly longer in LSPDP group (9.8 ± 2.0 vs 5.3 ± 1.1 cm, P = .007). The median follow-up was 39 months (range 12-57 months). No patient was confronted by tumor recurrence. The proportion of postoperative pancreatin and insulin treatment in LCP group were similar to LSPDP group (9 vs 17%, P = .383; 0 vs 3%, P = 1.000, respectively).For patients with poor general condition, the safety of LCP needs to be taken seriously; in some ways, LSPDP may be more secure, physiological, and easier operation for tumor located in pancreatic neck and proximal body.

Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy., Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition., Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life., Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy., Competing Interests: The authors have no conflicts of interest to disclose.

Purpose: Solid-pseudopapillary tumor (SPT) of pancreas is a rare entity with a low malignant potential. We aimed to identify the safety and the feasibility of laparoscopic distal pancreatectomy for SPT., Methods: From May 2008 to August 2011, we performed 4 cases of laparoscopic, spleen-preserving, distal pancreatectomies for patients with SPT. We retrospectively collected the demographic characteristics, operative and postoperative details, and follow-up outcomes of the patients., Results: Three female patients and 1 male patient with SPT underwent laparoscopic, spleen-preserving, distal pancreatectomy. The average operating time was 200 minutes. The average blood loss was 90 mL. The postoperative course of these patients was uneventful. All patients were followed-up and no local recurrence or metastasis was found., Conclusions: Laparoscopic distal pancreatectomy for patients with SPT is safe and feasible, with preferable operative outcomes, long-term tumor-free survival, and high spleen-preserving rate.

Objective: We summarized the diagnosis, surgical strategies, and long-term follow-up outcomes in our large series of solid pseudopapillary tumors (SPTs) of pancreas., Methods: In this retrospective analysis, we collected data pertaining to pancreatic SPTs diagnosed in 115 patients between July 2003 and February 2013.We analyzed the demographic characteristics, clinical presentations, operative strategies, perioperative details, and follow-up outcomes., Results: Abdominal pain was the most frequent symptom (40.0%). The most frequent location of SPT was pancreatic tail (36.5%). We performed 33 cases of pancreaticoduodenectomy, 15 cases of middle pancreatectomy, 19 cases of distal pancreatectomy with spleen preservation, 28 cases of distal pancreatectomy with splenectomy, and 18 cases of enucleation. Two patients suffered tumor recurrence and required a second resection of the recurrent tumor., Conclusions: Complete resection of the tumor is associated with good survival, even in patients with vessel involvement or metastases. In patients with tumor recurrence, a second resection resulted in long-term survival.

Laparoscopic vascular repair is technically challenging in pancreatic surgeries. We present a case of a 42-year-old woman who was initially admitted to our hospital because of upper abdominal pain. Preoperative abdominal enhanced CT scan revealed a cystic mass near the spleen that was 4.7 × 4.3 × 3 (cm) in dimension. Therefore, we performed laparoscopic spleen-preserving distal pancreatectomy. In this procedure, we repaired spleen-related vessels with laparoscopic suture due to the adhesion between the vessels and the tumor. Finally, the spleen was preserved with good blood supply. This procedure took 200 min and the estimated blood loss was 360 ml. The postoperative abdominal Doppler ultrasound carried out 6 days after surgery indicated blood supply to the spleen was good and there was no thrombosis. The patient was discharged without any complications on postoperative day 7. The pathological diagnosis was pancreatic mucinous cystadenoma.

Background: Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) has not been widely performed due to its technical challenging. We introduce a novel approach, named "Plane first" approach, for L-RAMPS in this study.Methods: From January 2015 to August 2021, we performed 51 cases of L-RAMPS. Patients were divided into two groups basing on the surgical approach: conventional approach (group 1) and "Plane first" approach (group 2). Data were retrospectively collected in terms of demographic characteristics, intra-operative variables, post-operative variables, and follow-up outcomes.Results: The age, sex, BMI, and tumor size were comparable between two groups. Two patients in the group 1 required converting to open surgery. The patients in the group 2 required fewer operative time (210.5 ± 65.5 min vs. 252.4 ± 24.7 min, p < 0.01). They also suffered from less blood loss (136.0 ± 100.0 ml vs. 158.8 ± 137.0 ml, p = 0.15). The overall complications for patients in two groups were comparable. In terms of oncological outcomes, posterior margin was positive in two patients (10.5%) in the group 1. One patient (3.1%) in the group 2 had positive pancreatic neck margin. The number of lymph nodes harvested and overall survival between the two groups were comparable.Conclusion: "Plane first" approach RAMPS for patients with pancreatic adenocarcinoma in the left pancreas is safe and feasible, even in patients with PV/SMV involvement. [ABSTRACT FROM AUTHOR]

Background: The Beger procedure is a common surgical option in the management of the unremitting abdominal pain of chronic pancreatitis (CP). As an organ-sparing surgery, it might be a better choice than pancreatoduodenectomy (PD). However, it is rather challenging for surgeons to perform the Beger procedure laparoscopically, especially for patients with CP; indeed, it has rarely reported. Here, we describe the technique and results of our early experience in laparoscopic Beger procedure for the treatment of CP.Case Presentation: Five patients (1 male) with CP (alcohol induced, n = 3; idiopathic, n = 2) who underwent laparoscopic Beger procedure from May to October 2019 in West China Hospital were included in this study. The median pancreatic duct diameter was 6.8 (4 to 12) mm. The median operating time was 275 (150 to 305) minutes without conversion. Only one patient (20%) developed a grade B pancreatic fistula. One patient required re-operation for jejunal anastomotic bleeding on the first post-operative day. The median hospital stay was 11 (9 to 34) days. No patient experienced biliary fistula, gastroparesis, duodenal necrosis, or abdominal bleeding. The 90-day mortality rate was 0%. All the patients were pain free in the two months after the operation.Conclusion: The laparoscopic Beger procedure is feasible and safe with good short-term results and some potential benefits in selected patients with chronic pancreatitis. Further study and longer follow-up are required. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon’s hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons’ hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic pancreaticoduodenectomy (LPD) technique with artificial vascular graft reconstruction for patients with borderline resectable pancreatic cancer has been rarely reported since it is a very challenging technique. However, preliminary experience for the technique has been reported at the Department of Pancreatic Surgery, West China Hospital, Sichuan University.1,2 The rising popularity of neoadjuvant chemotherapy for pancreatic cancer patients may result in the increase of operative difficulty due to tissue edema and many other factors caused by the chemotherapy. The main aim of this study was to demonstrate the feasibility, safety, and key surgical procedure for LPD using video evidence. Methods: A three-dimensional upper abdominal computed tomography angiography (CTA) scan done to a 51-year-old man brought to the center with upper abdominal pain showed a mass in the uncinate process of the pancreas, with over 180-degree involvement of the superior mesenteric vein. Percutaneous transhepatic cholangial drainage (PTCD) was performed to reduce jaundice while endoscopic ultrasound and fine-needle aspiration (EUS-FNA) were done to confirm the diagnosis of adenocarcinoma. The patient underwent two cycles of neoadjuvant chemotherapy using albumin-bound paclitaxel gemcitabine + program. The chemotherapy helped in significantly relieving the symptoms where CA 199 reduced from 586.7 IU/ml to 36.73 IU/ml, and the tumor maximum diameter was reduced from 4.3 cm to 2.2 cm. The violated superior mesenteric vein (SMV) and the tumor were en bloc resected, and a 4.0-cm artificial vascular graft was placed for reconstruction. Bing's anastomosis was performed using pancreaticojejunostomy3 while cholangiojejunostomy was performed using continuous stitching. The gastroduodenal artery (GDA) stump was wrapped with ligamentum teres hepatis after the completion of gastrointestinal anastomosis. The specimen was then removed through the extended umbilical incision (4 cm) and the operation was completed after the drainage tube was placed. Results: The length of intraoperative excisional SMV, duration of artificial vascular graft reconstruction, operation time, and volume of intraoperative blood loss were 4.0 cm, 30 min, 520 min, and 800 mL, respectively. Histopathological examination of ypT2N1 indicated that 1 of the 27 lymph nodes was positive. Pathological results showed a moderately differentiated adenocarcinoma with all margins being negative. Conclusions: This study demonstrated the feasibility of total laparoscopic pancreaticoduodenectomy combined with vascular resection and artificial vascular graft reconstruction in properly selected cases of pancreatic cancer with vein involvement after neoadjuvant chemotherapy. It is worth noting that skilled laparoscopic technicians and effective teamwork are necessities for safe completion of the procedure. [ABSTRACT FROM AUTHOR]