Donisi G, Zerbi A. Exploring the landscape of minimally invasive pancreatic surgery: Progress, challenges, and future directions. World J Gastrointest Surg 2024; 16(10): 3094-3103 [PMID: 39575294 DOI: 10.4240/wjgs.v16.i10.3094]
Corresponding Author of This Article
Greta Donisi, MD, Academic Fellow, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20090, Milan, Italy. greta.donisi@humanitas.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3094-3103 Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3094
Exploring the landscape of minimally invasive pancreatic surgery: Progress, challenges, and future directions
Greta Donisi, Alessandro Zerbi
Greta Donisi, Alessandro Zerbi, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
Greta Donisi, Alessandro Zerbi, Department of Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
Author contributions: Zerbi A and Donisi G contributed to this paper; Zerbi A designed the overall concept and outline of the manuscript; Donisi G contributed to the discussion and design of the manuscript; Zerbi A and Donisi G contributed to the writing, and editing the manuscript, illustrations, and review of literature.
Conflict-of-interest statement: Greta Donisi and Alessandro Zerbi have nothing to disclose.
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: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Greta Donisi, MD, Academic Fellow, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20090, Milan, Italy. greta.donisi@humanitas.it
Received: May 27, 2024 Revised: July 9, 2024 Accepted: July 15, 2024 Published online: October 27, 2024 Processing time: 123 Days and 11.3 Hours
Abstract
Minimally invasive surgery (MI) has become the standard of care for many surgical procedures aimed at reducing the burden on patients. However, its adoption in pancreatic surgery (PS) has been limited by the pancreas’s unique location and the complexity of the dissection and reconstruction phases. These factors continue to contribute to PS having one of the highest morbidity and mortality rates in general surgery. Despite a rough start, MIPS has gained widespread acceptance in clinical practice recently. Robust evidence supports MI distal pancreatectomy safety, even in oncological cases, indicating its potential superiority over open surgery. However, definitive evidence of MI pancreaticoduodenectomy (MIPD) feasibility and safety, particularly for malignant lesions, is still lacking. Nonetheless, reports from high-volume centers are emerging, suggesting outcomes comparable to those of the open approach. The robotic PS increasing adoption, facilitated by the wider availability of robotic platforms, may further facilitate the transition to MIPD by overcoming the technical constraints associated with laparoscopy and accelerating the learning curve. Although the MIPS implementation process cannot be stopped in this evolving world, ensuring patient safety through strict outcome monitoring is critical. Investing in younger surgeons with structured and recognized training programs can promote safe expansion.
Core Tip: Implementation of minimally invasive pancreatic surgery (MIPS) is a process that cannot be stopped. Minimally invasive (MI) distal pancreatectomy is now well-supported by evidence showing its safety and potential superiority over open surgery. Although the feasibility and definitive evidence for MI pancreaticoduodenectomy (MIPD) remain under investigation, high-volume centers have reported promising outcomes. The rise of robotic pancreatic surgery is poised to overcome technical limitations and enhance the transition to MIPD. Ensuring patient safety through rigorous monitoring and structured training of surgeons is crucial for the continued safe implementation of MIPS.
