Asbun Domenech, Stauffer John A, Asbun Horacio J
Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
J Gastrointest Oncol. 2024 Aug 31;15(4):1827-1835. doi: 10.21037/jgo-23-784. Epub 2024 Aug 28.
Laparoscopic distal pancreatectomies (LDP) confer benefits over open distal pancreatectomies (ODP). These benefits extend to patients with known malignancies. Despite being a common procedure for pancreatic surgeons, widespread adoption of minimally invasive approaches is still not universal. Improved understanding of the benefits of LDP as well as operative steps can help further spread the use of minimally invasive techniques.
The authors present their approach to LDP with an emphasis on anatomy, intraoperative technique, and pearls/pitfalls. A brief historical overview of the development of LDP and landmark studies is also included.
Review of milestones along the evolution of LDP are presented, showcasing the controversies and advantages that are associated with the procedure. Current perspectives and society recommendations are also discussed. Operative steps of LDP are described via the "clockwise technique". This technique outlines a step-wise method that includes wide mobilization for adequate exposure, slow compression of pancreatic parenchyma, and other important pearls such as patient positioning and operative planning.
Proper understanding of LDP is crucial to maximizing positive outcomes from the operation. Further education on technical pearls can help increase use of minimally invasive approaches to distal pancreatic resection for cancer.
腹腔镜远端胰腺切除术（LDP）比开放远端胰腺切除术（ODP）更具优势。这些优势也适用于已知患有恶性肿瘤的患者。尽管LDP是胰腺外科医生常用的手术，但微创方法的广泛应用仍未普及。更好地理解LDP的益处以及手术步骤有助于进一步推广微创技术的使用。
作者介绍了他们进行LDP的方法，重点阐述了解剖学、术中技术以及要点/陷阱。还包括LDP发展的简要历史回顾和具有里程碑意义的研究。
展示了LDP发展历程中的里程碑回顾，凸显了该手术相关的争议和优势。还讨论了当前的观点和学会建议。通过“顺时针技术”描述了LDP的手术步骤。该技术概述了一种逐步方法，包括广泛游离以获得充分暴露、缓慢挤压胰腺实质，以及其他重要要点如患者体位和手术规划。
正确理解LDP对于使手术获得最大积极效果至关重要。对技术要点的进一步培训有助于增加对癌症患者进行微创远端胰腺切除术的应用。
