Mitsuhiro Asakuma, PhD, Tetsunosuke Shimizu, PhD, Fumitoshi Hirokawa, PhD, Yoshihiro Inoue, PhD, Michihiro Hayashi, PhD, Kazuhisa Uchiyama, PhD. Osaka Medical College
Introduction: Single port surgery has been described since 2009 with cholecystectomy, colectomy, gastrectomy, and others. Nevertheless, few cases are still reported in field of HBP surgery. Herein, we report single port pancreatic surgery developed from our previous experience. We had started single port surgery in 2009, since then we have done more than 850 cases of single port surgery using surgical glove port including cholecystectomy, appendectomy, and colectomy. Because we consider this experience should develop to pancreatic surgery, 73 cases of single port staging laparoscopy for potentially resectable and borderline resectable pancreatic cancer and 15 cases of single port plus one port distal pancreatectomy (SPOP-DP) have been done in our institution.
Single port staging laparoscopy for pancreatic cancer
Resectability was proved in 63 (86%) out of 73 patients while 10 patents had unresectale factor such as small liver and peritoneal metastases that was not able to detect pre-operatively. The length of hospital days were 5.0±4.8days and the days to chemotherapy were 33.1±2.8days.
Single port plus one port distal pancreatectomy (SPOP-DP)
SPOP-DP starts with 1.5cm skin incision on umbilicus. Subsequently, a wound retractor is installed at umbilical wound. Then, a non-powdered surgical glove (5.5 inches) is put on the wound retractor through which three 5-mm slim trocars and one 12-mm trocar are inserted via each finger tips. A semi-flexible laparoscopic camera is inserted via the middle finger port. 12-mm port is used when laparoscopic US, mechanical stapler, endo intestinal clip or retrieval bag were needed. An additional 5-mm port is inserted at left subcostal lesion mainly used for surgeon’s right hand instrument. Gastric posterior wall is fixed to abdominal wall by suture instead of manual retraction. Pre-compression before transection of the pancreas was done using endo intestinal clip before firing.
Discussion: As we have seen in these two decades, surgery has dramatically been changed by laparoscopic surgery or robotic surgery. Nevertheless, because of technical difficulty and relatively high post-operative complication rate, introduction of reduced port surgery to HBP surgery has just started. SPOP-DP using endo intestinal clip, glove port and gastric wall hanging method is feasible. But its advantage is not clear so far, multicenter RCT is highly desired to clear the benefit of reduced port surgery for pancreas.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86972
Program Number: P533
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster