Laparoscopic pancreatic surgery (LapPS) for management of benign pancreatic
tumors has still not been defined. This paper evaluates the feasibility and outcome of LapPS in patients with endocrine pancreatic
tumors (EPTs) and
cystic neoplasms of the pancreas (CyNP). Eighteen patients with benign pancreatic
tumors underwent LapPS between January 1998 and May 2001. The indications were 10 EPTs (6 sporadic
insulinomas, 1 multiple
insulinoma of
multiple endocrine neoplasia type 1, 2 nonfunctioning
tumors, 1
VIPoma) and 8 CyNPs (3
serous cystadenomas, 5 mucinous
cystic neoplasms). The laparoscopic procedure was performed using four ports with patients in the half-lateral position. Laparoscopic ultrasonography (LapUS) was used in all cases. Laparoscopic enucleation (LapE) was planned in five patients and performed in four (one conversion for
tumor not found during laparoscopy). Laparoscopic pancreatic resection (LapPR) with spleen salvage was planned in 13 patients and performed in 12 (one conversion for metastatic
VIPoma), with splenic vessel preservation in 11 patients and short gastric vessel preservation in 1. The average operating time was 3.5 hours after enucleation, 4.0 hours after distal
pancreatectomy, and 5.0 hours after subtotal
pancreatectomy.
Pancreatic fistula was observed in two patients after LapE and in three patients after LapPR.
Splenectomy for splenic
abscess was performed 1 week after surgery in a patient with short gastric vessel splenic preservation. The average
hospital stay was 5 days. We concluded that LapPS is a safe method for removing EPTs and CyNPs, although the incidence of
pancreatic fistulas remains high. In selected patients LapPS offers significant benefit to patients: reduced
trauma to the abdominal wall, short
hospital stay, and a quick postoperative recovery.