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Surgical approaches for minimally invasive distal pancreatectomy: A systematic review

Authors
 Daisuke Ban  ;  Giovanni Maria Garbarino  ;  Yoshiya Ishikawa  ;  Goro Honda  ;  Jin-Young Jang  ;  Chang Moo Kang  ;  Aya Maekawa  ;  Yoshiki Murase  ;  Yuichi Nagakawa  ;  Hitoe Nishino  ;  Takao Ohtsuka  ;  Anusak Yiengpruksawan  ;  Itaru Endo  ;  Akihiko Tsuchida  ;  Masafumi Nakamura 
Citation
 JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, Vol.29(1) : 151-160, 2022-01 
Journal Title
JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
ISSN
 1868-6974 
Issue Date
2022-01
MeSH
Humans ; Laparoscopy* ; Minimally Invasive Surgical Procedures ; Pancreatectomy ; Pancreatic Neoplasms* / surgery ; Treatment Outcome
Keywords
laparoscopic distal pancreatectomy ; minimally invasive pancreatectomy ; spleen-preserving ; surgical approach ; vascular anatomy
Abstract
Background: Minimally invasive distal pancreatectomy (MIDP) was initially performed for benign tumors, but recently its indications have steadily broadened to encompass other conditions including pancreatic malignancies. Thorough anatomical knowledge is mandatory for precise surgery in the era of minimally invasive surgery. However, expert consensus regarding anatomical landmarks to facilitate the safe performance of MIDP is still lacking.

Methods: A systematic literature search was performed using keywords to identify articles regarding the vascular anatomy and surgical approaches/techniques for MIDP.

Results: All of the systematic reviews revealed that MIDP was not associated with an increase in postoperative complications. Moreover, most showed that MIDP resulted in less blood loss than open surgery. Regarding surgical approaches for MIDP, a standardized stepwise procedure improved surgical outcomes, including blood loss, operative time, and major complications. There are two approaches to the splenic vessels, superior and inferior; however, no study has ever directly compared them with respect to clinical outcomes. The morphology of the splenic artery affects the difficulty of approaching the artery's root. To select an appropriate dissecting layer when performing posterior resection, thorough knowledge of the anatomy of the fascia, left renal vein/artery, and left adrenal gland is needed.

Conclusions: In MIDP, a standardized approach and precise knowledge of anatomy facilitates safe surgery and has the advantage of a shorter learning curve. Anatomical features and landmarks are particularly important in cases of radical MIDP and splenic vessel preserving MIDP.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jhbp.902
DOI
10.1002/jhbp.902
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188326
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