[Laparoscopic surgery of pancreas].
In pancreatic diseases, laparoscopic surgery is used to drain fluid collections in infected pancreatic necrosis, abscesses and pseudocysts, for cancer staging, to resect both benign and malignant tumors and for palliative procedures as well. In patients with intractable pain, percutaneous or surgical celiac plexus block can be performed, celiac ganglion alcoholization and torachoscopic splacnicectomy can be done. The laparoscopic approach for staging, allows us to identify very small peritoneal or hepatic metastasis, local invasion or deep hepatic metastasis. The lack of tactile sensation is a disadvantage in the laparoscopic procedures for both staging and resection; which can be compensated utilizing laparoscopic ultrasound. The laparoscopic pancreatic approach for resection is useful to treat neuroendocrine tumors, chronic pancreatitis and cystic neoplasm allowing preservation of the splenic vessels and the spleen. The insulinoma is a treatable laparoscopic tumor given its unique characteristics. The preoperative diagnosis is made by image studies like ultrasound, CAT scans, angiography studies, MRI, endoscopic ultrasound and calcium stimulation test. There are three surgical options: enucleation, distal pancreatectomy with or without preserving the spleen. The most important complication is the pancreatic fistula.


CONCLUSIONS
The laparoscopic approach in pancreatic surgery is a feasible and safe one, although, its superiority over the classic open approach has not been demonstrated yet.
España-Gómez
María Nayví
MN
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF.
Pantoja
Juan Pablo
JP
Herrera
Miguel F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010179:Pancreas / Q000601:surgery; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome