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Zhu YP, Ni JJ, Chen RB, Matro E, Xu XW, Li B, Hu HJ, Mou YP. Successful interventional radiological management of postoperative complications of laparoscopic distal pancreatectomy. World J Gastroenterol 2013; 19:8453-8458. [PMID: 24363541 PMCID: PMC3857473 DOI: 10.3748/wjg.v19.i45.8453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/10/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
During the past decade, laparoscopic distal pancreatectomy (LDP) has gained increasing acceptance in the surgical community as a viable treatment option for distal pancreatic lesions. However, the possible complication of post-LDP pancreatic leakage remains a challenge, because it may lead to a series of events resulting in intraperitoneal abscess formation, sepsis, pseudoaneurysm formation, and occasional fatal hemorrhage. Dealing with these complications is extremely difficult and not much experience has been reported to date. We report a case involving the aforementioned post-LDP complications successfully managed by interventional radiological techniques while avoiding reoperation. We conclude that these management options are attractive, safe and minimally invasive alternatives to standard protocols.
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Gaujoux S, Allen PJ. Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World J Gastrointest Surg 2010; 2:283-90. [PMID: 21160897 PMCID: PMC2999692 DOI: 10.4240/wjgs.v2.i9.283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/18/2010] [Accepted: 09/24/2010] [Indexed: 02/06/2023] Open
Abstract
Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.
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Affiliation(s)
- Sebastien Gaujoux
- Sebastien Gaujoux, Peter J Allen, Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C-887, New York, NY 10021, United States
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Al-Taan OS, Stephenson JA, Briggs C, Pollard C, Metcalfe MS, Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford) 2010; 12:239-43. [PMID: 20590893 PMCID: PMC2873646 DOI: 10.1111/j.1477-2574.2010.00168.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 02/02/2010] [Indexed: 12/12/2022]
Abstract
Pancreatic surgery is still associated with a relatively high morbidity and mortality compared with other specialties. This is a result of the complex nature of the organ, the difficult access as a result of the retroperitoneal position and the number of technically challenging anastomoses required. Nevertheless, the past two decades have witnessed a steady improvement in morbidity and a decrease in mortality achieved through alterations of technique (particularly relating to the pancreatic anastomoses) together with hormonal manipulation to decrease pancreatic secretions. Recently minimally invasive pancreatic surgery has been attempted by several centres around the world which has stimulated considerable interest in this approach. The majority of the cases attempted have been distal pancreatectomies, because of the more straightforward nature of the resection and the lack of a pancreatic ductal anastomosis, but more recently reports of laparoscopic pancreaticoduodenectomy have started to appear. The reports of the series to date have been difficult to interpret and although the results are claimed to be equivalent or better than those associated with a traditional approach a careful examination of the literature and comparison with the best results previously reported does not presently support this. In the present review we examined all the reports of pancreatic procedures performed laparoscopically and compared the results with those previously achieved at open surgery.
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Javle M, Shah P, Yu J, Bhagat V, Litwin A, Iyer R, Gibbs J. Cystic pancreatic tumors (CPT): predictors of malignant behavior. J Surg Oncol 2007; 95:221-8. [PMID: 17323335 DOI: 10.1002/jso.20648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Due to widespread use of imaging studies, increasing cystic pancreatic tumor (CPT) cases are being detected. The diagnosis of malignancy in CPT cases requires pancreatectomy. Clinical and laboratory characteristics of CPT may predict underlying malignancy. METHODS CPT cases treated between 1994 and 2004 at our institution were included. Pseudocysts were excluded. Serous cystadenoma (SCA), mucinous cystadenoma (MCA), intrapapillary mucinous tumor, cystic endocrine tumor, and lymphoepithelial cysts were classified as benign or pre-malignant. Serous cystadenocarcinoma (SCACA), mucinous cystadenocarcinoma (MCACA), and adenocarcinoma (ACA) were classified as malignant. RESULTS Thirty-five patients had histological confirmation. Median age was 65 years. Male/female ratio was higher in malignant group (P = 0.0284). Weight loss and abdominal mass were more prevalent in malignant group (P = 0.042 and 0.028, respectively). Malignant lesions were larger, associated with local invasion (superior mesenteric artery (SMA), superior mesenteric vein (SMV), portal vein (PV) complex or celiac encasement) and CA 19-9 elevation. On univariate analyses, local invasion (P = 0.0029), negative surgical intervention (P = 0.0010), presence of ACA (P = 0.0044), or malignant CPT (P = 0.0018) were associated with shorter survival. On a multivariate analysis, local invasion was associated with shorter survival [Hazard ratio (HR) = 4.322, P = 0.0218], while surgical intervention was associated with improved survival (HR = 0.179, P = 0.0124). CONCLUSION Male sex, abdominal mass, weight loss, larger tumor size, local invasion, and elevated CA 19-9 were associated with malignant CPT.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- CA-19-9 Antigen/blood
- Female
- Humans
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Invasiveness
- Neoplasms, Cystic, Mucinous, and Serous/mortality
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatectomy
- Pancreatic Cyst/mortality
- Pancreatic Cyst/pathology
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Retrospective Studies
- Sex Factors
- Weight Loss
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Affiliation(s)
- Milind Javle
- Department of Medicine, Roswell Park Cancer Institute, and State University at Buffalo, Buffalo, New York 14263, USA.
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Aluka KJ, Long C, Rickford MS, Turner PL, McKenna SJ, Fullum TM. Laparoscopic distal pancreatectomy with splenic preservation for serous cystadenoma: a case report and literature review. Surg Innov 2007; 13:94-101. [PMID: 17012149 DOI: 10.1177/1553350606291339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A minimally invasive approach can be beneficial in a spleen-preserving distal pancreatectomy. This article reports a 71-year-old woman who presented to her internist with hypertension and persistent hypokalemia. A computed tomography scan to rule out a functional adrenal mass incidentally revealed a 4 cm x 3 cm x 2 cm serous cystadenoma of the distal pancreas and normal adrenal glands. The patient was referred to the general surgery service for resection of the distal pancreatic lesion. A laparoscopic spleen-preserving distal pancreatectomy was performed. The lesion was completely excised, and the pathology revealed serous cystadenoma with focal fibrosis and atrophic acini. The postoperative advantages of this approach were the early return of bowel function, minimal narcotic requirements, and early resumption of normal activities. This case illustrates the advantages of minimally invasive surgery in the performance of a spleen-preserving distal pancreatectomy.
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Affiliation(s)
- Kanayochukwu J Aluka
- Department of Surgery, Providence Hospital, Washington, District of Columbia, USA.
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Abstract
In parallel with the increasing move from open surgical procedures to laparoscopic approaches, laparoscopic ultrasound (LUS) is being used with increasing frequency to image normal structures and intra-abdominal pathology. Special transducers and scanning techniques are required to perform LUS with a different set of considerations. Within the spectrum of LUS applications, LUS is used to complement laparoscopy for oncology staging, to facilitate an array of surgical procedures, and to guide laparoscopic biopsies.
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Affiliation(s)
- Suvranu Ganguli
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Abstract
Primary cystic neoplasms of the pancreas (serous cystic neoplasms, mucinous serous neoplasms, and intraductal papillary mucinous neoplasms) are lesions of emerging importance. With the wide availability of modern imaging methods, these neoplasms are being recognized with increasing frequency. Due to the improvement of these sophisticated imaging techniques, it is often possible to differentiate preoperatively these primary pancreatic cystic neoplasms not only from other cystic pancreatic disorders (such as pancreatic pseudocysts) but also from one another. This differentiation is very important for the clinician, since these neoplasms have radically different biologic behavior. Serous cystic neoplasms are uniformly benign and usually do not mandate resection unless the lesion is symptomatic. In contrast, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms have a premalignant or overtly malignant tendency, and therefore should be managed aggressively by pancreatic resection. In these mucinous cystic neoplasms, recognition of an underlying malignancy is often not possible without a detailed histopathologic examination of the entire resected specimen. In the absence of invasive disease, prognosis is excellent after appropriate surgery. The presence of invasive malignancy signifies a poor prognosis.
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MESH Headings
- Biopsy, Fine-Needle
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/therapy
- Cholangiopancreatography, Endoscopic Retrograde
- Cystadenocarcinoma/diagnosis
- Cystadenocarcinoma/diagnostic imaging
- Cystadenocarcinoma/epidemiology
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/surgery
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenocarcinoma, Papillary/diagnosis
- Cystadenocarcinoma, Papillary/therapy
- Cystadenocarcinoma, Serous/diagnosis
- Cystadenocarcinoma, Serous/therapy
- Diagnosis, Differential
- Humans
- Laparoscopy
- Magnetic Resonance Imaging
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Prognosis
- Tomography, X-Ray Computed
- Ultrasonography
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Affiliation(s)
- George H Sakorafas
- Department of Surgery, 251 Hellenic Air Force (HAF) Hospital, Messogion and Katehaki Avenue, 115 25 Athens, Greece, and Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Abstract
Advances in minimally invasive surgery have revolutionized the field of surgery. Despite the great strides in equipment and experience, operative conduct remains confined by the limits of exposure. Retroperitoneal fat can be abundant and can contribute greatly to difficulty in exposure. Visceral organs ventral to the retroperitoneum preclude direct access and require optimal patient positioning to operate. Additionally, the major vascular pedicles all originate in the retroperitoneum off of the abdominal aorta or enter the inferior vena cava. The pancreas, in particular, is surrounded by the portal vein, celiac axis, superior mesenteric vein and artery, and splenic vein and artery. If injured during surgery, these vessels can present a life-threatening emergency. The issues related to the vasculature, coupled with the difficulty in resecting portions of the pancreas and the relative paucity of pancreatic procedures, have greatly concentrated these cases at tertiary care centers staffed by experienced laparoscopists. However, as surgical technology improves and fellowships train more surgeons with advanced laparoscopic skills, minimally invasive pancreatic surgery may diffuse with more community-based health care networks.
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Affiliation(s)
- Daniel Tseng
- Department of Surgery, Oregon Health and Science University, Portland, Oregon 97201, USA
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Palomeque A, Manuel Ramia J, Villar J, Mansilla A, Garrote D, Antonio Ferrón J. Tumores quísticos mucinosos del páncreas. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cioffi U, De Simone M, Santambrogio R, Fortis D, Ferrero S, Ciulla MM, Montorsi M. Laparoscopic enucleation of solitary true pancreatic cyst in an adult. J Gastrointest Surg 2003; 7:921-4. [PMID: 14592669 DOI: 10.1007/s11605-003-0041-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Solitary or true pancreatic cyst is a very rare pathologic condition; only a few cases are reported in literature. We report a case of a 22-year-old woman with a symptomatic true pancreatic cyst located in proximity to the pancreatic head, duodenum, vena cava, biliary tree, and right kidney, which was enucleated through a laparoscopic approach. Laparoscopic ultrasound imaging allowed the surgeon to better identify the morphology of the cyst and its relationship with the adjacent structures. The treatment is briefly reviewed and discussed.
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Affiliation(s)
- Ugo Cioffi
- Departments of Surgery, Ospedale Maggiore di Milano, IRCCS, Milan, Italy.
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Schachter PP, Shimonov M, Czerniak A. The role of laparoscopy and laparoscopic ultrasound in the diagnosis of cystic lesions of the pancreas. Gastrointest Endosc Clin N Am 2002; 12:759-67, vii-viii. [PMID: 12607785 DOI: 10.1016/s1052-5157(02)00029-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With the widespread use of advanced imaging techniques, cystic lesions of the pancreas are now diagnosed relatively frequently. The nature of these lesions vary from benign cysts (serous cvstadenoma) or an inflammatory process (pseudocyst), to premalignant (mucinous cystadenoma) or frankly malignant lesions (cystadenocarcinoma). Differentiation of various types of pancreatic cysts presents a diagnostic and therapeutic challenge, as clinical presentation may be vague. Laparoscopic ultrasonography (LAPUS), the biopsy of the cystic wall, and analysis of the cystic aspirate, although expensive and rather invasive procedures, significantly contribute to the differential diagnosis of pancreatic cystic lesions.
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Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J. Is laparoscopic left pancreatic resection justified? Surg Endosc 2002; 16:1358-61. [PMID: 11984672 DOI: 10.1007/s00464-001-9206-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Accepted: 12/20/2001] [Indexed: 12/12/2022]
Abstract
BACKGROUND We reviewed our experience of laparoscopic left pancreatectomy to establish the feasibility of this approach and the characteristics of the operating procedure. METHODS Thirteen patients with a mean age of 60 years were deemed for a left pancreatectomy. Preoperative diagnoses were: nine mucinous cystadenoma and one insulinoma, intraductal mucinous ectasia, chronic pancreatitis with ductal stenosis, and distal pancreatic tumor. RESULTS Operative mortality was nil. Two patients required conversion for bleeding from splenic vein injuries leading to a splenectomy in one case. The spleen was preserved in 10 cases. Postoperative course was uneventful in nine cases. Four patients experienced postoperative complications: one pancreatic fistula, two liquid cysts on the pancreatic margin, and one reoperation for bleeding from a trocar port. Length of stay ranged from 5 to 22 days. CONCLUSION These preliminary results confirm that in selected cases laparoscopic resection of the left pancreas is feasible and safe.
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Affiliation(s)
- J M Fabre
- Department of Surgery, Saint Eloi Hospital, 34295 Montpellier Cedex 5, France.
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Akagi T, Sasaki A, Bandoh T, Matsumoto T, Aramaki M, Kawano K, Kitano S. Diagnostic usefulness of laparoscopic fine‐needle aspiration for intraductal papillary tumor of the pancreas. Dig Endosc 2002. [DOI: 10.1046/j.1443-1661.2001.00147.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Tomonori Akagi
- Department of Surgery I, Oita Medical University, Oita, Japan
| | - Atsushi Sasaki
- Department of Surgery I, Oita Medical University, Oita, Japan
| | - Toshio Bandoh
- Department of Surgery I, Oita Medical University, Oita, Japan
| | | | | | | | - Seigo Kitano
- Department of Surgery I, Oita Medical University, Oita, Japan
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Fabre M. Diagnostic des lésions kystiques du pancréas par l'aspiration à l'aiguille fine guidée sous échoendoscopie digestive Quel prélèvement et pourquoi? Utilité de la microbiopsie sur la paroi du kyste et de l'analyse du liquide en technique monocouche. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/bf03018032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The discovery of a cystic lesion in the pancreas implies a challenge for the physician. Approximately 10% are cystic tumors, benign to highly malignant, or true cysts, showing all stages of cellular differentiation, from benign to highly malignant tumors. Malignant cystic tumors are rare and comprise only about 1% of all pancreatic malignancies, they are potentially curable. Therefore, correct diagnosis and treatment of these lesions are of great importance. It is usually not possible to separate a pseudocyst from a benign cyst or a cystic tumor, but there are some signs and findings that could be helpful in the clinical decision. The diagnosis of a cystic pancreatic tumor requires different imaging techniques, including ultrasonography, computerized tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, but to distinguish a pseudocyst or a benign cyst from a potentially malignant lesion can be very difficult. The usefulness of blood tests and investigations of cyst fluid can be questionable. Today, surgical treatment of cystic pancreatic tumors can be performed with low morbidity. Therefore, we conclude that an active strategy with resection of cystic tumors of the pancreas should be recommended.
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Affiliation(s)
- T Gasslander
- Department of Surgery, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
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Abstract
The surgical treatment of pancreatic pseudocysts (PC) has a less important role now that endoscopic and radiologic intervention can effectively treat PC. Surgery may be needed to correct the underlying cause--usually an obstructed or disrupted pancreatic duct.
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Schachter P, Sorin V, Avni Y, Shimonov M, Friedman V, Rosen A, Czerniak A. The role of laparoscopic ultrasound in the minimally invasive management of symptomatic hepatic cysts. Surg Endosc 2001; 15:364-7. [PMID: 11395816 DOI: 10.1007/s004640090000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2000] [Accepted: 10/18/2000] [Indexed: 11/29/2022]
Abstract
BACKGROUND Now that the laparoscopic treatment of symptomatic liver cystic disease has proven feasible and safe, it is gaining wide acceptance. However, due to diagnostic pitfalls and a relatively high recurrence rate, further improvements and refinement of the procedure are still needed. We have evaluated the contribution of laparoscopic ultrasound in the diagnosis and management of patients with symptomatic liver cysts. METHODS Twelve patients with single or multiple cysts of the liver and two patients with polycystic liver disease were managed laparoscopically. Laparoscopic ultrasound served as an integral part of the procedure in all patients. RESULTS Patients underwent either complete cyst excision (two cases) or resection of the extrahepatic cystic component (eight cases). Additionally, in two patients, deep cysts not demonstrated by preoperative imaging studies were detected and treated with a combination of laparoscopy and laparoscopic ultrasound. In one patient with a cystobiliary fistula, conversion to an open cystjejunostomy was necessary. Patients with polycystic liver disease underwent a combination of excision and unroofing of both superficial and deeper cysts using laparoscopic contact ultrasound throughout the procedure. Laparoscopic ultrasonography was found to have a significant impact on the operative strategy in five patients (36%) with multiple cysts or polycystic disease. The postoperative course was uneventful in all cases. Thirteen patients remained asymptomatic throughout the follow-up period of 30 months; one patient with polycystic liver disease developed recurrent symptoms after 5 months and was treated with left hepatectomy. CONCLUSION Additional use of laparoscopic ultrasound enables the detection, differentiation, and treatment of deep, nonvisualized cystic lesions (two patients, 16.6%) and validation of the adequacy of the laparoscopic procedure.
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Affiliation(s)
- P Schachter
- Department of Surgery A, The E. Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon 58160, Tel Aviv, Israel.
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Pertsemlidis D, Edye M. Diagnostic and interventional laparoscopy and intraoperative ultrasonography in the management of pancreatic disease. Surg Clin North Am 2001; 81:363-77. [PMID: 11392423 DOI: 10.1016/s0039-6109(05)70124-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The laparoscopic management of pancreatic disorders has evolved dramatically from its inception in 1911 and its rediscovery in the 1970s. Although investigators once proclaimed that "it seems unlikely that laparoscopy will have any more than an extremely limited use in the investigation of pancreatic disorders," laparoscopy and LUS now have a well-recognized role in the staging of pancreatic cancer and an increasing part in the management of benign pancreatic disease at many institutions. Although the appropriate role of LS and LUS is debatable, the development and refinement of laparoscopic techniques and instrumentation and the improvement of noninvasive diagnostic modalities will provide new data, increase the rate of resection at laparotomy, and allow surgeons to treat a broader range of pancreatic disease by minimally invasive methods. The value of LS and LUS for benign and malignant pancreatic disorders has been clearly demonstrated, but the inevitable issues of hospital resource, operative expertise, and surgical philosophy will ultimately determine the role of laparoscopy and LUS in clinical practice.
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Affiliation(s)
- D Pertsemlidis
- Department of Surgery, New York University School of Medicine, New York, USA
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Abstract
Pancreatic cystic neoplasms are uncommon, but are being detected at an increased rate in the current era of sophisticated abdominal imaging. The selection of appropriate treatment depends on the ability to distinguish benign from malignant cysts. The most common clinical mistake is to treat a cystic neoplasm as a benign pseudocyst. The identification of a cyst as a cystic neoplasm should be suspected on clinical grounds, but the differentiation from a benign cyst is often difficult based on clinical features and imaging alone. Analysis of cystic fluid for tumor markers and cytology should be considered, using newer approaches such as endoscopic ultrasound-guided fine needle aspiration (FNA), in those patients in whom this information may guide appropriate therapy. Surgical excision of a cystic pancreatic neoplasm is the treatment of choice in patients fit for surgery. Inappropriate treatment of these lesions as pseudocysts, by radiographic, endoscopic, or surgical drainage, is to be avoided. Resection of the lesion should be seriously considered even in the absence of symptoms, as these lesions have malignant potential and are often curable.
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