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Focus on Laparoscopic Pancreatic Surgery

Epublication, May 2017;17(05). URL: http://websurg.com/doi/fc01en25
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ERAS, fast track perioperative management in HPB surgery
In this key lecture, Dr. DeJong describes the concept of the enhanced recovery after surgery (ERAS) project with the objectives of fast-track preoperative, intraoperative, and postoperative management in HPB surgery. He highlights a breakthrough project run in the Netherlands with discharge criteria along with other national initiatives in the UK, Sweden, France, and worldwide with examples of randomized clinical trials. He describes the guidelines and initial experience of fast-track liver surgery with the ERAS pancreas program and compares it to the ORANGE-II trial. He outlines the PANDA trial with or without drain, and puts forward the recommendations for perioperative management.
CHC DeJong
Lecture
1 year ago
750 views
49 likes
0 comments
24:01
ERAS, fast track perioperative management in HPB surgery
In this key lecture, Dr. DeJong describes the concept of the enhanced recovery after surgery (ERAS) project with the objectives of fast-track preoperative, intraoperative, and postoperative management in HPB surgery. He highlights a breakthrough project run in the Netherlands with discharge criteria along with other national initiatives in the UK, Sweden, France, and worldwide with examples of randomized clinical trials. He describes the guidelines and initial experience of fast-track liver surgery with the ERAS pancreas program and compares it to the ORANGE-II trial. He outlines the PANDA trial with or without drain, and puts forward the recommendations for perioperative management.
Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.
HJ Asbun
Lecture
1 year ago
4108 views
160 likes
0 comments
33:33
Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.