title: Full laparoscopic total pancreatectomy with and without spleen and pylorus preservation: a feasibility report.
abstract: OBJECTIVE
  Laparoscopic pancreatic surgery is gaining acceptance and clear advantages have been demonstrated in distal resection. Total pancreaticoduodenectomy (TPD) combines the operative steps of distal pancreatectomy and pancreaticoduodenectomy, but facilitates reconstruction and lowers the risk of common complications by avoiding the need for a pancreatic anastomosis. The aim of this report is to analyse the feasibility of laparoscopic total pancreaticoduodenectomy, with and without spleen and pylorus preservation.
  
  
  METHODS
  Two patients underwent laparoscopic TPD for pancreatic intraductal mucinous neoplasm and endocrine tumors. Total splenopancreaticoduodenectomy (TSP) and pylorus- and spleen-preserving total pancreaticoduodenectomy (PSPTP) were performed.
  
  
  RESULTS
  The two procedures were successfully completed laparoscopically. PSPTP was more time-consuming (420 vs. 360 min) and had an increased risk of hemorrhage (600 vs. 200 ml) compared with TSP. After both procedures, the postoperative outcome was uneventful and the postoperative length of hospital stay was 8 days.
  
  
  CONCLUSIONS
  This report confirms the feasibility of full laparoscopic TPD, and presents the first full laparoscopic pylorus- and spleen-preservation technique with conservation of the splenic vessels, without robotic assistance. No conclusions can be drawn from this report, but it shows that the laparoscopic approach provides visual magnification, improved exposure, and delicate manipulation of tissues, which may reproduce the clear advantages of laparoscopic distal pancreatectomy.
authors: Department of Digestive and Endocrine Surgery, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), University Hospital of Strasbourg, IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. bernard.dallemagne@ircad.fr.
authors: Bernard
authors: B
authors: Dallemagne
authors: Antonio Talvane Torres
authors: AT
authors: de Oliveira
authors: Croider Franco
authors: CF
authors: Lacerda
authors: Jacopo
authors: J
authors: D'Agostino
authors: Henry
authors: H
authors: Mercoli
authors: Jacques
authors: J
authors: Marescaux
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D013154:Spleen / Q000601:surgery*
keywords: endocrine pancreatic tumors; intraductal pancreatic mucinous neoplasm (IPMN); laparoscopic total pancreatectomy; laparoscopy; pancreas