Minireview on laparoscopic hepatobiliary and pancreatic surgery

Abstract

The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious.

Keywords: Laparoscopic, Liver resection, Pancreatectomy, Cholecystectomy, Pancreaticoduodenectomy, Cancer, Tumour

Core tip: This minireview presents the importance of laparoscopy in facilitating laparoscopic hepatobiliary and pancreatic surgery, and the efficacy and safety of laparoscopic hepatobiliary and pancreatic surgery. Laparoscopic surgery is the preferred management of benign and malignant disease for selected patients. The advantages include confirmation of diagnosis, prevention of nontherapeutic operations, decreased hospital stay and better post-operative function and cosmetic outcome. Meta-analyses demonstrate that laparoscopic liver resections, pancreatectomies and cholecystectomies are efficacious. There is less blood loss; the hospital stays are shorter with laparoscopic surgeries. There is no compromise to the oncological resection margins when compared to open surgery. Laparoscopic surgery is safe and efficacious in the management of benign and malignant hepatobiliary and pancreatic diseases.