Yuyao Song, Guodong Zhao, Rong Liu, Zhiming Zhao, Yuanxing Gao, Zhuzeng Yin, Yong Xu. Chinese PLA General hospital
Background: Laparoscopic surgery for proximal pancreatic disease remains controversial due to the challenging anatomic pathways involving the gastrocolic ligament. In this study, we present a novel laparoscopic approach through an operation of the stoma of the right side of the mesenteric vessels,R-Hole for short,to enucleate proximal pancreatic lesions. We discuss the safety and efficacy of this approach to expand indications for laparoscopic pancreatic surgery.
Methods: A retrospective study was designed to compare the surgical outcomes of 15 cases who underwent a laparoscopic enucleation of proximal pancreatic neuroendocrine tumours via the R-hole approach (RHA)and 15 cases who underwent a laparoscopic enucleation of proximal pancreatic tumours via the gastrocolic ligament approach (GLA). All cases underwent surgery for proximal neuroendocrine pancreatic lesions (≤ 2.5cm diameter) from August 2010 to November 2017[Office1] .The novel laparoscopic approach was designed to go through the transverse mesocolon to obtain direct access and easy manipulation.
Results: Compared with the GLA group,the RHA group exhibited a significantly shorteroperative time (mean 82.00 vs. 153.67 min), shorter hospital stay (mean 10.00vs. 20.27 days), and comparable blood loss (mean 81.33vs. 94.00ml). No significant difference was observed between the two groups in terms of open conversion rate, complication rate, and 90-daymortality rate.No relapse was detected in the follow-up period of 34.47± 14.73 months.
Conclusions: Our initialr esults indicate that laparoscopic enucleation via the mesocolon R-Hole approach would be a safer and more feasible alternative approach for selected proximal pancreatic lesions,with the potential advantages of easier exposure, shorter operative time, more simple manipulation, and shorter postoperative recovery than the conventional approach via the gastrocolic ligament.
Keywords: Anatomical pathway; pancreas; enucleation; mesocolon; laparoscopy; minimally invasive surgery
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95012
Program Number: P684
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster