Laparoscopic resection of the pancreas A feasibility study of the short-term outcome B. Edwin, 1 T. Mala, 1 Ø. Mathisen, 1 I. Gladhaug, 1 T. Buanes, 2 O. C. Lunde, 3 O. Søreide, 4 A. Bergan, 1 E. Fosse 1 1 Interventional Center and Surgical Department, Rikshospitalet, Oslo, Norway 2 Ulleva˚l University Hospital, Oslo, Norway 3 Aker University Hospital, Oslo, Norway 4 Center for Health Technology Assessment, Sintef, 0314, Oslo, Norway Received: 12 January 2003/Accepted: 22 August 2003/Online publication: 2 February 2004 Abstract Background: Laparoscopic resection is not an estab- lished treatment for tumors of the pancreas. We report our preliminary experience with this innovative ap- proach to pancreatic disease. Methods: Thirty two patients with pancreatic disease were included in the study on an intention-to-treat basis. The preoperative indications for surgery were as follows: neuroendocrine tumors (n=13), unspecified tumors (n=11), cysts (n=2), idiopathic thrombocytopenic purpura with ectopic spleen (n=2), annular pancreas (n=1), trauma (n=1), aneurysm of the splenic artery (n=1), and adenocarcinoma (n=1). Results: Enucleations (n=7) and distal pancreatectomy with (n=12) and without splenectomy (n=5) were per- formed. Three patients underwent laparoscopic explo- ration only. Four procedures (13%) were converted to an open technique. One resection was converted to a hand-assisted procedure. The mortality rate for patients undergoing laparoscopic resection was 8.3% (two of 24). Complications occurred after resection in nine of 24 procedures (38%). The median hospital stay was 5.5 days (range, 2–22). Postoperatively, opioid medication was given for a median of 2 days (range, 0–13). Conclusion: Resection of the pancreas can be performed safely via the laparoscopic approach with all the poten- tial benefits to the patients of minimally invasive surgery. Key words: Laparoscopic surgery — Pancreas — Short-term outcome — Pancreatectomy The laparoscopic approach has been applied to an in- creasing number of indications in recent years. For the pancreas, its use has been limited to exploratory pro- cedures and the staging of patients with malignancy and to palliative procedures. However, recent feasibility studies have suggested that patients do benefit from laparoscopic resection of the pancreas [5, 6, 9–12]. Widespread use of the laparoscopic approach has been precluded in pancreatic surgery by the technically de- manding nature of the procedure and the fact that the effects of laparoscopy in patients with malignant dis- eases remain controversial. Resectable tumors in the distal pancreas are un- common and of varying etiology [6, 14]. Patients with chronic pancreatitis may also occasionally be candidates for resection of the distal pancreas [2, 5]. Three main types of resection of the distal pancreas may be ac- complished: (a) enucleation of tumors, (b) distal pan- createctomy in conjunction with splenectomy, and (c) spleen-preserving distal pancreatectomy [6, 12]. We reviewed our preliminary experience and results with laparoscopic resection of the pancreas in selected patients, with the aim of assessing the safety and feasi- bility of such procedures. Materials and methods Thirty two patients with pancreatic disease, 20 female and 12 male, admitted between March 1997 and May 2002 to the surgical depart- ment of the Rikshospitalet (29 patients), Ulleva˚l University Hospital (two patients), and Aker University Hospital (one patient), Oslo, Norway, were included in the study on an intention-to-treat basis. In the study period, all patients with distal pancreatic tumors who were operated on at the Rikshospitalet were included. All case notes were reviewed. Informed consent was obtained from all patients. The number of patients operated on each year varied between two and nine. Median age was 56 years (range, 21–81). The American Society of Anesthesiologists (ASA) physical status score of the patients is shown in Fig. 1. Eight patients had had previous abdominal operations for various reasons. The preoperative diagnoses are shown in Table 1. Indications for surgery were based on clinical symptoms, clinical biochemistry, and radiologic and endoscopic investigations. Magnetic resonance imaging Correspondence to: T. Mala Surg Endosc (2004) 18: 407–411 DOI: 10.1007/s00464-003-9007-y Ó Springer-Verlag New York Inc. 2004