Initial experience with hand-assisted laparoscopic distal pancreatectomy

M. D'Angelica, Chandrakanth Are, W. Jarnagin, G. DeGregoris, D. Coit, D. Jaques, M. Brennan, Y. Fong

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Hand-assisted laparoscopic distal pancreatectomy, with or without splenectomy, is gradually gaining acceptance, although its ultimate benefit is yet to be confirmed. This study aimed to report our initial experience with hand-assisted laparoscopic distal pancreatectomy. Methods: A retrospective review of a prospectively collected database including 17 patients during the period 2002-2004 was conducted. The median age was 60 years (range, 29-85 years), and the female-to-male ratio was 13:4. The preoperative diagnoses included benign and malignant conditions. Besides two to three ports, a hand port was placed in the upper midline to aid in dissection. The pancreas was divided with a stapler in all the patients, and drains were placed in 10 patients (70%). Results: One patient was found to be unresectable because of celiac artery involvement, and 2 of the remaining 16 patients underwent conversion to an open procedure. The median operating time was 196 min (range, 128-235 min). The mean tumor size was 4 cm (range, 2-7 cm), and the estimated blood loss was 125 ml (range, 50-1,250 ml). The median time to resumption of a regular diet was 3.5 days (range, 2-9 days), and the time to conversion to oral pain medications was 3 days (range, 2-9 days). The length of hospital stay was 5.5 days (range, 4-18 days), with a majority of the patients (11 patients, 78%) staying less than 7 days. There were no mortalities. The overall postoperative morbidity rate was 25%, and the morbidities consisted of pancreatic leak/fistula (2 patients, 14%) and fever (1 patient). The margins were negative in 10 (76%) of the relevant 13 patients. At a median follow-up period of 3.8 months (range, 5-14 months), 11 (84%) of 13 patients had no evidence of disease recurrence. Conclusion: The minimally invasive approach to pancreatic disease is safe and technically feasible. Further large studies with longer follow-up periods are necessary to determine the role of laparoscopic surgery in the management of pancreatic disease.

Original languageEnglish (US)
Pages (from-to)142-148
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2006
Externally publishedYes

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Pancreatectomy
Hand
Pancreatic Diseases
Length of Stay
Celiac Artery
Conversion to Open Surgery
Morbidity
Pancreatic Fistula
Splenectomy
Laparoscopy
Dissection
Pancreas
Fever
Databases
Diet

Keywords

  • Hand-assisted
  • Laparoscopic distal pancreatectomy
  • Minimally invasive
  • Pancreatectomy
  • Pancreatic disease

ASJC Scopus subject areas

  • Surgery

Cite this

Initial experience with hand-assisted laparoscopic distal pancreatectomy. / D'Angelica, M.; Are, Chandrakanth; Jarnagin, W.; DeGregoris, G.; Coit, D.; Jaques, D.; Brennan, M.; Fong, Y.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 1, 01.01.2006, p. 142-148.

Research output: Contribution to journalArticle

D'Angelica, M, Are, C, Jarnagin, W, DeGregoris, G, Coit, D, Jaques, D, Brennan, M & Fong, Y 2006, 'Initial experience with hand-assisted laparoscopic distal pancreatectomy', Surgical Endoscopy and Other Interventional Techniques, vol. 20, no. 1, pp. 142-148. https://doi.org/10.1007/s00464-005-0209-3
D'Angelica, M. ; Are, Chandrakanth ; Jarnagin, W. ; DeGregoris, G. ; Coit, D. ; Jaques, D. ; Brennan, M. ; Fong, Y. / Initial experience with hand-assisted laparoscopic distal pancreatectomy. In: Surgical Endoscopy and Other Interventional Techniques. 2006 ; Vol. 20, No. 1. pp. 142-148.
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abstract = "Background: Hand-assisted laparoscopic distal pancreatectomy, with or without splenectomy, is gradually gaining acceptance, although its ultimate benefit is yet to be confirmed. This study aimed to report our initial experience with hand-assisted laparoscopic distal pancreatectomy. Methods: A retrospective review of a prospectively collected database including 17 patients during the period 2002-2004 was conducted. The median age was 60 years (range, 29-85 years), and the female-to-male ratio was 13:4. The preoperative diagnoses included benign and malignant conditions. Besides two to three ports, a hand port was placed in the upper midline to aid in dissection. The pancreas was divided with a stapler in all the patients, and drains were placed in 10 patients (70{\%}). Results: One patient was found to be unresectable because of celiac artery involvement, and 2 of the remaining 16 patients underwent conversion to an open procedure. The median operating time was 196 min (range, 128-235 min). The mean tumor size was 4 cm (range, 2-7 cm), and the estimated blood loss was 125 ml (range, 50-1,250 ml). The median time to resumption of a regular diet was 3.5 days (range, 2-9 days), and the time to conversion to oral pain medications was 3 days (range, 2-9 days). The length of hospital stay was 5.5 days (range, 4-18 days), with a majority of the patients (11 patients, 78{\%}) staying less than 7 days. There were no mortalities. The overall postoperative morbidity rate was 25{\%}, and the morbidities consisted of pancreatic leak/fistula (2 patients, 14{\%}) and fever (1 patient). The margins were negative in 10 (76{\%}) of the relevant 13 patients. At a median follow-up period of 3.8 months (range, 5-14 months), 11 (84{\%}) of 13 patients had no evidence of disease recurrence. Conclusion: The minimally invasive approach to pancreatic disease is safe and technically feasible. Further large studies with longer follow-up periods are necessary to determine the role of laparoscopic surgery in the management of pancreatic disease.",
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AU - Are, Chandrakanth

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AU - DeGregoris, G.

AU - Coit, D.

AU - Jaques, D.

AU - Brennan, M.

AU - Fong, Y.

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