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  • Review Article
  • Published:

Laparoscopic pancreatic surgery for benign and malignant disease

Nature Reviews Gastroenterology & Hepatology volume 13, pages 227–238 (2016)Cite this article

Subjects

This article has been updated

Key Points

  • Indications for pancreatic resection do not differ for laparoscopic or open surgery; whether a pancreatic resection can be performed laparoscopically depends on the surgeon's training and experience

  • Most studies on laparoscopic distal pancreatectomy have reported outcomes superior to the open approach, mainly regarding intraoperative blood loss, spleen preservation, length of stay and overall costs

  • Laparoscopic Whipple has similar outcomes to the open approach, although inferior outcomes have been associated with the initial learning curve phase and when this procedure is performed in low-volume hospitals

  • Laparoscopic pancreatic surgery is associated with a considerable learning curve effect, necessitating structured introduction by trained surgeons and substantial case volumes per centre

  • Randomized data are needed before drawing conclusions on definite benefits of a laparoscopic approach; the first randomized controlled trials on laparoscopic pancreatic surgery are ongoing

Abstract

Laparoscopic surgery for benign and malignant pancreatic lesions has slowly been gaining acceptance over the past decade and is being introduced in many centres. Some studies suggest that this approach is equivalent to or better than open surgery, but randomized data are needed to assess outcomes. In this Review, we aim to provide a comprehensive overview of the state of the art in laparoscopic pancreatic surgery by aggregating high-quality published evidence. Various aspects, including the benefits, limitations, oncological efficacy, learning curve and latest innovations, are discussed. The focus is on laparoscopic Whipple procedure and laparoscopic distal pancreatectomy for both benign and malignant disease, but robot-assisted surgery is also addressed. Surgical and oncological outcomes are discussed as well as quality of life parameters and the cost efficiency of laparoscopic pancreatic surgery. We have also included decision-aid algorithms based on the literature and our own expertise; these algorithms can assist in the decision to perform a laparoscopic or open procedure.

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Figure 1: Anatomical structures involved in pancreatic surgery.
Figure 2: Decision-aid algorithm for laparoscopic Whipple.
Figure 3: Decision-aid algorithm for laparoscopic distal pancreatectomy.
Figure 4: Techniques for spleen-preserving distal pancreatectomy.

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Change history

  • 18 February 2016

    In the version of this article initially published online, the first sentence of the abstract misspelled "Laparoscopic". This error has now been corrected in the HTML and PDF versions of this article.

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Author notes

  1. Thijs de Rooij and Sjors Klompmaker: Both authors contributed equally to this work

Authors and Affiliations

  1. Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands

    Thijs de Rooij, Sjors Klompmaker, Olivier R. Busch & Marc G. Besselink

  2. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, UK

    Mohammad Abu Hilal

  3. Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, 55905, Minnesota, USA

    Michael L. Kendrick

Authors
  1. Thijs de Rooij
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  2. Sjors Klompmaker
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  3. Mohammad Abu Hilal
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  4. Michael L. Kendrick
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  5. Olivier R. Busch
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  6. Marc G. Besselink
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Contributions

All authors researched data for the article and provided a substantial contribution to discussion of the content. T.d.R. and S.K. wrote the article. M.A.H., M.L.K., O.R.B. and M.G.B. contributed to reviewing and editing the manuscript before submission.

Corresponding author

Correspondence to Marc G. Besselink.

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Competing interests

T.d.R., O.R.B. and M.G.B. received educational grants from Ethicon (Johnson & Johnson Medical) to perform a nationwide training programme in laparoscopic pancreatic surgery (NLEG00569, BNLEA00021, BNLEA00065) and a research grant from Ethicon (Johnson & Johnson Medical) to perform a randomized controlled multicentre trial on laparoscopic versus open distal pancreatectomy (IIS 14–702). S.K., M.A.H. and M.L.K. declare no competing interests.

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de Rooij, T., Klompmaker, S., Hilal, M. et al. Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 13, 227–238 (2016). https://doi.org/10.1038/nrgastro.2016.17

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