There are mutiple chioces of surgical approaches in la laparoscopic pancreatectomy such as trans-gastrocolic ligament,
trans-hepatogastric ligament and trans-transverse mesocolon. The recently reported retroperitoneoscopic pancreatectomy had
enriched the options. No crosswise comparisons have been made among the approaches while it is a critical surgical issue to
choose a well-exposed one according to the characteristics of the pancreatic lesions. This article try to explain the reason for the
choice of different approach based on our laparoscopic pancreatic experience. Advantages and disadvantages of each option will
Approval was obtained from the Institutional Review Board.
67 patients received the laparoscopic pancreatectomies from Jan 2010 to Mar 2013 which included 17 cases of robotic assisted
distal pancreatectomies (9 cases were spleen-preserved), 9 cases of retroperitoneoscopic pancreatectomies, 41 cases of laparoscopic
pancreatectomies (12 cases were trans-transverse mesocolon, 24 cases were trans-gastrocolic ligament, 5 cases used the both).
Subgroup where divied based on the charcteristics of lesions and the type of surgery. Operative time, blood loss, conversion to
laparotomy, complications, LOS(length of stay) were compared in the subgroup. Approval was obtained from the Institutional
All the 17 cases of robotic assisted distal pancreatectomies used the both approaches. 2 cases converted to laparotomy
and 1 case of laparoscopic second-look surgery was performed for the postoprative bleeding. There have been a significant
diffference in the charcteristics of lesions and the type of surgery among the subgroup. The both approaches were used at the
same time in the patients with bigger lesions (>2.5 cm), spleen-preserved and most laparoscopic distal panceatomies. The single
approach were used in patient with smalled lesion. The prefered approached should be choosed based on the MRI before the
operation. News approach should be added while single approach were not exposed well enough. Mutipple approaches have no
clinical influence significantly while the potential risk such as intra-abdominal adhesions are still possible.
Mulitiple surgical approach have enriched the options for the laparoscopic pancreatic surgery. The choice shoud
based onm the volume of the lesions and the type of the surgery to expose well enough and to reduce the unnecessary dissection.
Our experience show that there is no significant influence on the hospital stay of the patients. Single approach can be used
safely after imaging tests piror to the operation. The indications and limitation of each aproach should be awared and practised
skillfully, which is the basic requiement for the laparoscopic surgery.
Liu Rong has completed his Ph.D. at the age of 31 years from the second military medical university. He is the director of Department of Surgical
Oncology, Chinese People?s Liberation Army (PLA) General Hospital. He has published more than 15 papers in reputed journals and serving as an
editorial board member of repute.
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