Laparoscopic Management of Pancreatic Disease

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Laparoscopic Management of Pancreatic Disease
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Laparoscopic Pancreatic Surgery

• Experience Open Pancreatic Surgery
• Two handed laparoscopic skills
• Laparoscopic suturing skills

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Laparoscopic Management of Pancreatic Pseudocysts

• Patient Selection
• Similar to open management
• Symptomatic patient
• Pseudocyst adjacent to posterior wall of stomach,
  base of mesocolon, or duodenum

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Pancreatic Psuedocyst
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CYST
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Dissection

• Swing epigastric port to left side of the
  falciform
• Retraction of the lateral segment of the liver
• Ultrasound Identification of the Pseudocyst

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Anterior Gastrotomy

• Harmonic/Ultrasonic Scalpel
• Stapler

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Dissection

• Reapply ultrasound through gastrotomy
• Enter cyst with Hook cautery
• Suction initial contents

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Dissection and Decompression

• Widen the tiny posterior gastrotomy bluntly
• Apply sequential staplers in a diamond fashion
• Biopsy
• Suction, debride, irrigate

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Laparoscopic Management of Parenchymal Disease

• Patient Selection
• Lesion within neck, body, tail
• Periampullary lesions
• Patient positioning
• modified right lateral decubitus
• approximately 45-60 degrees

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Exposure of Pancreatic Lesion

• Mobilize spleen and pancreatic tail

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SPLEEN
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PANCREAS
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PANCREATIC LESION
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PANCREAS DIVIDED WITH STAPLER
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CUT EDGE OF PANCREAS