Laparoscopic pancreatic enucleation
Epublication WebSurg.com, May 2017;17(05). URL: http://websurg.com/doi/lt03endallemagne016
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 <2-3cm). Tumor location is the most important technical factor. The main criterion for the resection is the distance between the tumor and Wirsung’s duct. Laparoscopic ultrasound is a mandatory tool for this technique as it helps to localize the tumor and rule out additional tumors which can be missed during the preoperative work-up. There are two types of surgical techniques, namely the medial approach in which the patient lies in a supine position, and the lateral approach. The lateral approach is appropriate to mobilize the pancreatic tail and to check its distal part. It is also essential as it allows for a precise enucleation. A medial approach provides access to the whole aspect of the pancreas. The surgeon stands between the patient’s legs and the use of a 30-degree angulated scope is key to see the anterior surface of the pancreas. Laparoscopic pancreatic enucleation is contraindicated in the presence of MEN 1 syndrome, gastrinoma, and/or when malignancy is suspected.