Laparoscopic Central Pancreatic Resection or Laparoscopic Median Pancreatectomy

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Laparoscopic Central Pancreatic Resection or Laparoscopic Median Pancreatectomy

Laparoscopic central pancreatic resection or laparoscopic median pancreatectomy

Overall facts about laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
1.This is a highly controversy procedure
2. It can be done via an open approach or via laparoscopic central pancreatectomy or so call laparoscopic median pancreatectomy

Indication for laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
1. Benign but symptomatic tumor of the pancreas located at the pancreatic neck or proximal body.
2. Pre-malignant cystic pancreatic tumor ( ie: mucinous cystic lesion) located at the pancreatic neck

Contraindication for laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
1. Malignant pancreatic tumor

Advantages of laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
1. Preservation of pancreatic body and tail. Therefore, lower the risk of subsequent development of diabetes mellitus

Disadvantages of laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
1. Removed minimal tissue, therefore, may not be as oncologic as one think.
2. No lymph node clearance
3. Two cut pancreatic surfaces, therefore a high risk of pancreatic leaks post operatively

Surgery
1. Open central pancreatectomy or median pancreatectomy
2. Laparoscopic central pancreatectomy or laparoscopic median pancreatectomy


Which one to go for if you need central pancreatectomy ?
One can always consider Laparoscopic central pancreatectomy or laparoscopic median pancreatectomy rather than open central pancreatectomy. The advantages of laparoscopic central pancreatectomy or laparoscopic median pancreatectomy are small incisions, less pain, quicker return of bowel activity, earlier resuming of oral intake, earlier ambulation, lower risk of DVT and pneumonia.

Therefore in selected patient and in an experience surgical hands, Laparoscopic central pancreatectomy or laparoscopic median pancreatectomy should be the operation of choice


Where to recieve laparoscopic central pancreatectomy or laparoscopic median pancreatectomy
Here at Kaiser Permanente, South San Francisco experienced laparoscopic surgeons we had performed a very successful laparoscopic central pancreatic resection or laparoscopic median pancreatectomy about 1 year ago. Patient did very well and was able to play golf at St Andrews ( Scotland) several week after surgery. No postoperative diabetes Mellitus.

Kaiser Permanente, South San Francisco experienced laparoscopic surgeons currently do not perform laparoscopic central pancreatectomy or laparoscopic median pancreatectomy for pancreatic adenocarcinoma

Contact about laparoscopic central pancreatectomy or laparoscopic median pancreatectomy

Laparoscopic pancreatic surgery

Pancreatic Surgery

In patients with malignant pancreatic tumor, aggressive pancreatic surgery is the only chances of long term survival. Most of these patient will also be treated with multimodality therapy either pre-operatively or postoperatively. Pancreatic surgery also offer patient a cure when the pancreatic tumor in benign or pre-malignant. In patients with chronic pancreatitis, pancreatic surgery can effectively palliate their symptoms of abdomen pain.

The type of pancreatic surgery

The type of pancreatic surgery is largely depends on the location of the tumor at the pancreas.

The anatomical location of the pancreas is divided into pancreatic head, uncinate process, pancreatic neck, pancreatic body and pancreatic tail.

For a pancreatic tumor at the head or uncinate process, Whipple operation is the operation of choice. For a pancreatic tumor at the body and tail of the pancreas, distal pancreatic resection is the operation of choice. For tumor in the pancreatic neck, the choice of surgery is slightly more controversy. If the tumor is benign (but symptomatic) or pre-malignant, then our choice is central pancreatic resection ( median pancreatectomy). However, if the tumor is deems malignant, then then choice of operation is either an extended distal pancreatic resection of whipple operation.

At Sacred Heart Medical Center, Eugene, OR, specialised surgeons can now offer all the pancreatic surgery mentioned to be done laparoscopically or in an open fashion. They have done laparoscopic whipple operation, laparoscopic central pancreatic resection, laparoscopic distal pancreatic resection with spleenic preservation or with spleenectomy. Laparoscopic enucleation is the standard of care for isolated pancreatic insulinoma.

These are the procedures offer in Sacred Heart Medical Center, Eugene, OR.

Pancreatic Tumor

Whipple operation
i. Laparoscopic Whipple operation
ii. Open Whipple operation

Central pancreatic resection (Median pancreatectomy)

Distal pancreatic resection
i. Laparoscopic distal pancreatectomy
1. Laparoscopic distal pancreatectomy with splenic preservation
2. Laparoscopic distal pancreatectomy with spleenectomy
ii. Open distal pancreatectomy

Pancreatic enucleation
i. Laparoscopic pancreatic tumor enucleation
ii. Open pancreatic tumor enucleation

Chronic pancreatitis

Pseudocyst drainage procedure
i. Laparoscopic cytogastrostomy
ii. Laparoscopic cystoduodenostomy
iii. Laparoscopic cystojejunostomy

Peustow’s operation ( pancreaticojejunostomy)
i. Laparoscopic Peustow’s Operation
ii. Open Peustow’s operation

Berger operation
i. Laparoscopic Berger operation
ii. Open Berger operation

Frey operation
i. Laparoscopic Frey operation
ii. Open Frey operation

Resection
i. Whipple operation ( laparoscopic whipple or open)Distal pancreatic resection

Laparoscopic Whipple operation

Video of laparoscopic whipple operation to come

Laparoscopic Whipple Operation

Who should perform laparoscopic Whipple operation ?

The quick answer is: Those who have the skills as laparoscopic Whipple operation is technically VERY challenging...

These are the surgeons not only has done lots of pancreatic surgery but also need to be fully trained in advanced laparoscopic surgery. Since laparoscopic fellowship training has only been around for about 5 years, therefore most of these surgeons are rather young.

Therefore, if you surgeons is an old surgeons, make sure you do not let him/her talk you into letting him/her do the laparoscopic Whipple operation.


In USA: There are only a few surgeons who has the skill set to complete laparoscopic Whipple operation.

Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

Variety of laparoscopic Whipple operation

1. Totally laparoscopic Whipple operation

In this approach, all the incisions are small, all the dissection and anastomosis are done by laparoscopic means.

This is a technically much more challenging operations and therefore only a few trained advanced laparoscopic surgeons can complete these a totally laparoscopic Whipple operation


2. Hand assisted laparoscopic Whipple operation

In this approach, all the dissections are done laparoscopically. When it come to performing the anastomosis, the surgeon make a large open incisions ( much bigger than the totally laparoscopic Whipple operation, but smaller than the classic open whipple operation)


Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

Potential advantage of laparoscopic Whipple operation.

Laparoscopic Whipple operations utilised several small incisions. Therefore, the advantages of laparoscopic Whipple operation will be:
1. Less perioperative pain
2. Early ambulation
3. Better return of full pulmonary functions
4. Less chances of developing DVT and pneumonia
5. Early return of bowel functions ( less narcotic use, early ambulation)
6. Lower incidence of incisional hernia



Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

Controversy with laparoscopic Whipple operation.

Whipple operation is one of the most major abdomen operation. Whipple operation is associated with significantly high perioperative complications. Since Dr Whipple described this operation, this surgery has been done with a LARGE incision. Often time extend from the right side of the abdomen to the left side ( almost to the very edge). The complication rate of Whipple operation is approximately 30 to 40 %. The perioperative mortality rate range from 0 % to 10%, average about 5%.

The controversy is what can a laparoscopic whipple operation improved these intrinsic complications.

Nobody can provide patients with an answer yet. As there need to have more data on the outcome of laparoscopic whipple operation.

However, just like most laparoscopic surgery, laparoscopic whipple operation has face many inersia of reluntancy.

However, in selected hand, most advanced laparoscopic pancreatic surgeons suspect that the result of laparoscopic whipple operation is equal and non-inferior to open whipple operation.

Certainly, we smaller incisions, post operative pain will be significantly improved.

Laparoscopic Whipple Operation

Operation for laparoscopic Whipple operation

1. It may take longer... sometime a safe surgery like laparoscopic whipple may takes 6 to 10 hours.
2. Hospital stays may range from 6 to 10 days.
3. Less pain from smaller incision
4. The intrinsic complications of whipple opeartion may not be minimised via laparoscopic Whipple operation



Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

Indication of Laparoscopic Whipple ( Laparoscopic Pancreatic Surgery)

Pancreatic Head Tumor:
1. Pancreatic adenocarcinoma ( tumor not involve the Portal Vein or Superior Mesenteric Vein)
2. Intraductal papillary mucinous neoplasm (IPMN)\
3. Pancreatic Neuroendocrine tumor
4. Pancreatic cystic tumor (mucinous)
5. Chronic pancreatitis

Contra-indication:
In patients who had previous abdomen opeartion, any laparoscopic surgery may be more challenging due to scar tissue ( adhesion), therefore laparoscopic pancreatic surgery, including laparoscopic whipple operation may be a bit more difficult but not impossible.


Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

Kaiser Permanente, South San Francisco experienced laparoscopic surgeons

Laparoscopic Whipple Operation

What is new with Laparoscopic Whipple Operation

Whipple operation is perhaps one of the most technically challenging operation in the abdomen. Now, we can do a total laparoscopic Whipple operation ! Amazing !!!

What is removed during Laparoscopic Whipple operation ?

It is amazing that a surgeon can now do whipple operation laparoscopically. This is the operation to remove tumor an the head of the pancreas most of the duodenum, distal common bile duct and some time part of the stomach.

This can be pancreatic adenocarcinoma, pancreatic neuroendocrine tumor and some symptomatic benign pancreatic tumor



Who should perform laparoscopic Whipple operation ?

Laparoscopic Whipple operation can be done safely in selected patients and by only a handful of trained surgeon in the world.

?The quick answer is: Those who have the skills as laparoscopic Whipple operation is technically VERY challenging...These are the surgeons not only has done lots of pancreatic surgery but also need to be fully trained in advanced laparoscopic surgery. Since laparoscopic fellowship training has only been around for about 5 years, therefore most of these surgeons are rather young.Therefore, if your surgeons is an old surgeons, make sure you do not let him/her talk you into letting him/her do the laparoscopic Whipple operation.

Where about in the USA can one get laparoscopic Whipple operation ?

In USA: There are only a few surgeons who has the skill set to complete laparoscopic Whipple operation.In Oregon: The available info that we have is as
follows:

http://www.peacehealth.org/Oregon/WhoWeAreSHMC.htm.





Variety of laparoscopic Whipple operation



1. Totally laparoscopic Whipple operation



In this approach, all the incisions are small, all the dissection and anastomosis are done by laparoscopic means.This is a technically much more challenging operations and therefore only a few trained advanced laparoscopic surgeons can complete these a totally laparoscopic Whipple operation



2. Hand assisted laparoscopic Whipple operation



In this approach, all the dissections are done laparoscopically. When it come to performing the anastomosis, the surgeon make a large open incisions ( much bigger than the totally laparoscopic Whipple operation, but smaller than the classic open whipple operation)




Potential advantage of laparoscopic Whipple operation.






Laparoscopic Whipple operations utilised several small incisions. Therefore, the advantages of laparoscopic Whipple operation will be:


1. Less perioperative pain
2. Early ambulation
3. Better return of full pulmonary functions
4. Less chances of developing DVT and pneumonia
5. Early return of bowel functions ( less narcotic use, early ambulation)
6. Lower incidence of incisional hernia






Potential disadvantages of laparoscopic Whipple operation


1. Longer operating time
2. More and earlier post-operative atelectasis.

Potential disadvantages of laproscopic Whipple operation that is likely not to be true

1. More bleeding
Surgeons that have done several of laparoscopic whipple operations showed that bleeding is not a problem, as they need to address bleeding, even in smaller amount as soon as possible, otherwise, their laparoscopic view will be affected)

2. Pooer oncologist outcome
This outcome of laparoscopic whipple or open whipple operation is likely going to be equal from oncology standpoint. There are minimal handling of the tumor during laparoscopic whipple operation, therefore tumor spread is minimised ( much so compare to open whipple operation)




Again..in experience hand, laparoscopic whipple can be done safely with good oncologic outcome




Controversy with laparoscopic Whipple operation.



Whipple operation is one of the most major abdomen operation. Whipple operation is associated with significantly high perioperative complications. Since Dr Whipple described this operation, this surgery has been done with a LARGE incision. Often time extend from the right side of the abdomen to the left side ( almost to the very edge). The complication rate of Whipple operation is approximately 30 to 40 %. The perioperative mortality rate range from 0 % to 10%, average about 5%.The controversy is what can a laparoscopic whipple operation improved these intrinsic complications.Nobody can provide patients with an answer yet. As there need to have more data on the outcome of laparoscopic whipple operation.However, just like most laparoscopic surgery, laparoscopic whipple operation has face many inersia of reluntancy.However, in selected hand, most advanced laparoscopic pancreatic surgeons suspect that the result of laparoscopic whipple operation is equal and non-inferior to open whipple operation.Certainly, we smaller incisions, post operative pain will be significantly improved.


Indication of Laparoscopic Whipple ( Laparoscopic Pancreatic Surgery)

Pancreatic Head Tumor:



1. Pancreatic adenocarcinoma ( tumor not involve the Portal Vein or Superior Mesenteric Vein)
2. Intraductal papillary mucinous neoplasm (IPMN)
3. Pancreatic Neuroendocrine tumor
4. Pancreatic cystic tumor (mucinous)
5. Chronic pancreatitis





Contra-indication for laparoscopic Whipple operation





In patients who had previous abdomen opeartion, any laparoscopic surgery may be more challenging due to scar tissue ( adhesion), therefore laparoscopic pancreatic surgery, including laparoscopic whipple operation may be a bit more difficult but not impossible





Laparoscopic Whipple operation in Oregon, USA





This is the info for laparoscopic whipple opeartion on Sacred Heart Medical Center web site home page athttp://www.peacehealth.org/Oregon/WhoWeAreSHMC.htm.

Laparoscopic pancreatic surgery, Laparoscopic Whipple

May 13, 2009

SPRINGFIELD, Ore. -- Laparoscopic Whipple Surgery is a technique only a handful of doctors around the world know how to pull of.


One of those surgeons is right here Kaiser Permanente, South San Francisco experienced laparoscopic surgeons Dr. Swee Teh has performed several of these operations


Using the tiniest of incisions, the surgeon is able to remove a portion of the pancreas, eliminating or reducing the size of cancerous tumors.