With regards to the pancreatic gland, what division and control techniques do you use (staples, Ligasure device, ultrasound, or regular sutures)?

This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.

We report the case of a robot-assisted pancreaticoduodenectomy for vaterian ampulloma. The patient is positioned in the French position with the assistant between the legs and the robot at the head. Five trocars are used: the camera is introduced through the umbilical trocar. The operation begins with the exploration of the peritoneum and of the liver. The gastric antrum is divided. Each structure of the hepatic pedicle is skeletonized. The superior border of the pancreas is dissected, hence allowing to approach the mesentericoportal axis.
The surgeon proceeds to the inferior border of the pancreas in order to find the mesentericoportal axis and to achieve a retropancreatic passage, which is where the pancreas will be divided. The pancreas is divided using the Sonicision™ cordless ultrasonic dissection device. The first jejunal loop is divided with a stapler. The specimen is totally mobilized ‘en bloc’, and freed from the portal vascular axis with a dissection of the right border of the coeliac trunk. At the end of the dissection, the different arterial and venous structures are skeletonized with a lymph node resection. The reconstruction is performed with a pancreaticogastrostomy, hepaticojejunostomy, and gastrojejunostomy.

Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreatic surgeries. Laparoscopic pancreatic resections have been performed in patients with a variety of diseases including chronic pancreatitis, pancreatic trauma, congenital hyperinsulinism. Laparoscopic proximal pancreatectomies for cancer with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy is technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences of highly skilled surgeons.
This interesting video shows all steps and landmarks of a totally laparoscopic duodenopancreatectomy for cancer performed by a very experienced surgeon.

This is the case of a robotic pancreaticoduodenectomy for an intraductal papillary mucinous neoplasm (IPMN) performed in a 50-year-old patient discovered on pancreatic MRI after three episodes of acute pancreatitis.

This is a case of a 50-year-old man with a solid tumor in the tail of the pancreas found during routine check-up ultrasound. The diagnostic work-up for neuro-endocrine tumor was negative. The patient was operated on in Hospital de Ipanema, Rio de Janeiro, Brazil by Dr. Eduardo Viana and his team. The histology confirmed it to be an adenocarcinoma.

Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Laparoscopic resection of insulinomas is feasible and safe. Laparoscopic ultrasound contributes to successful insulinoma localization and laparoscopic resection. This video shows a laparoscopic resection of an insulinoma located in the uncinate process of the pancreas.

Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.

Enucleation is a surgical procedure during which tumor cells only are removed, leaving the pancreas entirely intact. Enucleation can be performed using an open or laparoscopic surgical approach, although the laparoscopic procedure is generally preferred due to a quicker recovery. There is a number of indications for this technique, including insulinoma (which is benign in 90% of cases) and non-functioning tumor (with a size