UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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58 Updated Topics in Minimally Invasive Abdominal Surgery Because cancer cell invasion is dependent on protease activity, Gerota’s fascia may function as a barrier against protease-mediated invasion of cancer cells. Division of the pancreas, splenic artery, and splenic vein is done under direct vision through minilaparotomy at epigastrium. Following the division of the gastrocolic ligament, the posterior surface of the pancreatic neck is tunneled by blunt dissection. The pancreas is transected after ligating the left side of the pancreas. The splenic artery and vein are ligated and divided at the origin and at the confluence with the superior mesenteric vein, respectively. As mentioned by Fagniez and Munoz-Bongrand, early division of the pancreatic neck provides superior access to control the splenic vessels (Fagniez & Munoz- Bongrand, 1999). Then, division of the left gastroepiploic and short gastric vessels is done under laparoscope with left hand assistance. At this point, all drainage vessels from the pancreatic body and tail have been ligated and divided. Lastly, retroperitoneal dissection behind the Gerota’s fascia is performed lateral to medial direction laparoscopically. 5. Conclusion Laparoscopic assistance is useful in distal pancreatectomy. This technique can be applied to both benign and malignant lesions. For benign lesions, preservation of gastrosplenic ligament and extracorporeal preparation of transected pancreatic stump under direct vision are useful measures to prevent post-operative complications. 6. References Appu, S.; Young, A.B. & Lawrentschuk, N. (2005). Peritoneal “pillowcase” for the displaced spleen post-distal pancreatectomy. Journal of Hepatobiliary Pancreatic Surgery, Vol.12, pp. 470-473. Dexter, S.P.; Martin, I.G.; Leindler, L.; Fowler, R. & McMahon, M.J. (1999).Laparoscopic enucleation of a solitary pancreatic insulinoma. Surgical Endoscopy, Vol.13, pp. 406-408. Fagniez, P.L. & Munoz-Bongrand, N. (1999), Vascular control during left splenopancreatectomy in cancer. Annales de Chirurgie, Vol.53:, pp. 632-634, (in French with English abstract). Gagner, M. & Pomp, A. (1994), Laparoscopic pylorus-preserving pancreatoduodenectomy. Surgical Endoscopy, Vol.8, pp. 408-410. Gagner, M.; Pomp, A. & Herrera, M.F. (1996), Early experience with laparoscopic resections of islet cell tumors. Surgery, Vol.120, pp. 1051-1054. Hama, T.; Takifuji, K.; Uchiyama, K.; Tani, M.; Kawai, M. & Yamaue, H. (2008), Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. Journal of Hepatobiliary Pancreatic Surgery, Vol.15, pp. 304-309. Hirota, M.; Shimada, S.; Yamamoto, K.; Tanaka, E.; Sugita, H.; Egami, H. & Ogawa, M. (2005), Pancreatectomy using the no-touch isolation technique followed by extensive intraoperative peritoneal lavage to prevent cancer cell dissemination: a pilot study. JOP, Vol.6, pp. 143-151. Hirota, M.; Kanemitsu, K.; Takamori, H.; Chikamoto, A.; Ohkuma, T.; Komori, H.;
Laparoscopy-Assisted Distal Pancreatectomy Miyanari, N.; Ishiko, T. & Baba, H. (2007), Local pancreatic resection with preoperative endoscopic transpapillary stenting. American Journal of Surgery, Vol.194, pp. 308- 310. Hirota, M.; Ichihara, A.; Furuhashi, S.; Tanaka, H.; Takamori, H. & Baba, H. (2009), Spleen and gastrosplenic ligament preserving distal pancreatectomy under a minimum incision approach assisted by laparotomy. Journal of Hepatobiliary Pancreatic Surgery, Vol.16, pp. 792-795. Hirota, M.; Kanemitsu, K.; Takamori, H.; Chikamoto, A.; Tanaka, H.; Sugita, H.; Sand, J., Nordback, I. & Baba, H. (2010), Pancreatoduodenectomy using a no-touch isolation technique. American Journal of Surgery, Vol.199, pp. e65e68. Kaneko, H.; Takagi, S.; Joubara, N.; Yamazaki, K.; Kubota, Y.; Tsuchiya, M.; Otsuka, Y. & Shiba, T. (2004), Laparoscopy-assisted spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Journal of Hepatobiliary Pancreatic Surgery, Vol.11, pp. 397-401. Kimura, W.; Inoue, T.; Futakawa, N.; Shinkai, H.; Han, I. & Muto, T. (1996), Spleenpreserving pancreatectomy with conservation of the splenic artery and vein. Surgery, Vol.120, pp. 885-890. Kimura, W.; Yano, M.; Sugawara, S.; Okazaki, S.; Sato, T.; Moriya, T.; Watanabe, T.; Fujimoto, H.; Tszuka, K.; Takeshita, A. & Hirai, I. (2010). Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. Journal of Hepatobiliary Pancreatic Sciences, Vol. 17, pp. 813-823. Klingler, P.J.; Hinder, R.A.; Menke, D.M. & Smith, S.L. (1998), Hand-assisted laparoscopic distal pancreatectomy for pancreatic cystadenoma. Surgical Laparoscopy & Endoscopy, Vol.8, pp. 180-184. Mabrut, J.Y.; Fernandez-Cruz, L.; Azagra, J.S.; Bassi, C.; Delvaux, G.; Weerts, J.; Fabre, J.M.; Boulez, J.; Baulieux, J.; Peix, J.L.; Gigot, J.F.; Hepatobiliary and Pancreatic Section of the Royal Belgian Society of Surgery; Belgian Group for Endoscopic Surgery; & Club Coelio. (2005), Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery, Vol.137, pp. 597- 605. Patterson, E.J.; Gagner, M.; Salky, B.; Inabnet, W.B.; Brower. S.; Edye, M.; Gurland, B.; Reiner, M & Pertsemlides, D. (2001), Laparoscopic pancreatic resection: singleinstitution experience of 19 patients. Journal of the American College of Surgeons, Vol.193, pp. 281-287. Shinchi, H.; Takao, S.; Noma, H.; Mataki, Y.; Iino, S. & Aikou, T. (2001), Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, Vol.11, pp. 139-143. Sussman, L.A.; Christie, R. & Whittle, D.E. (1996), Laparoscopic excision of distal pancreas including insulinoma. Australian & New Zealand Journal of Surgery, Vol.66, pp. 414-416. 59
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UPDATED TOPICS IN MINIMALLY INVASIV
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free online editions of InTech Book
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VI Contents Chapter 9 Appendicitis
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Part 1 Laparoscopic Biliary-Pancrea
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4 Updated Topics in Minimally Invas
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Laparoscopic Liver Surgery [84] Les
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Part 3 Laparoscopic Appendectomy
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Laparoscopic Hernia Repair semicirc
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Laparoscopic Hernia Repair fascial
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Laparoscopic Hernia Repair elastic
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Laparoscopic Hernia Repair Laparosc
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Laparoscopic Hernia Repair defect.
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Laparoscopic Hernia Repair LeBlanc,
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Laparoscopic Incisional Hernia Repa
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Laparoscopic Approach to Abdominal
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UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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