Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1122-1135
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1122
Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres
Shamir O Cawich, Michael D Kluger, Wesley Francis, Rahul R Deshpande, Fawwaz Mohammed, Kimon O Bonadie, Dexter A Thomas, Neil W Pearce, Beth A Schrope
Shamir O Cawich, Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
Michael D Kluger, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY 10032, United States
Wesley Francis, Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
Rahul R Deshpande, Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Fawwaz Mohammed, Dexter A Thomas, Department of Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
Kimon O Bonadie, Department of Surgery, Health Service Authority, Georgetown 915 GT, Cayman Islands
Neil W Pearce, Department of Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
Beth A Schrope, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
Author contributions: Cawich SO, Schrope BA and Kluger MD designed and coordinated the study; Pearce NW, Bonadie KO, Deshpande R, Francis W and Mohammed F performed experiments, acquired and analyzed data; Cawich SO, Schrope BA, Kluger MD, Pearce NW, Bonadie KO, Deshpande R, Francis W and Mohammed F interpreted the data; Cawich SO and Kluger MD wrote the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: There are no conflicts of interest reported for any of the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shamir O Cawich, FACS, Professor, Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Tunapuna 331333, Trinidad and Tobago. socawich@hotmail.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: May 13, 2021
Revised: May 19, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: October 27, 2021
Processing time: 258 Days and 11.1 Hours

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the environment that many surgeons in developing countries work in. These patients often do not have the opportunity to travel to high volume centres for care. Therefore, we sought to review the existing data on MIS for the pancreas and to discuss. In this paper, we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas. The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice. Low pancreatic case volume in the Caribbean, and financial barriers to MIS in general, laparoscopic distal pancreatectomy, enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare environment. This is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.

Keywords: Pancreas, Surgery, Laparoscopic, Minimally invasive, Pancreatectomy, Whipple’s, Pancreaticoduidenectomy

Core Tip: The published data generally support the use of the minimally invasive approach for surgery on the pancreas. However, it has been under-utilized in the Caribbean because both minimally invasive surgery and service centralization for pancreatic surgery are in their infancy in the Caribbean. Only 3.25 Laparoscopic distal pancreatectomies are performed per annum across the entire region. In this paper we explore the obstacles to incorporating a minimally invasive service for pancreatic surgery.