Background In the past two decades, total pancreatectomy has been associated with improved postoperative and long-term outcomes due to the improvements in surgical technique, better enzyme preparations and diabetes control. While minimally invasive Whipple operation has enjoyed the attention in recent years, the safety and feasibility of a minimally invasive total pancreatectomy is still not established. Methods A retrospective review of minimally invasive total pancreatic resections. Results Seven patients underwent laparoscopic hand-assisted total pancreatectomy between 2005 and 2011. The mean patient age was 58.1 years (58.1 ± 6.45) and the median American Society of Anesthesiologist score was 3. Three patients had diffuse IPMN, two had multiple neuroendocrine tumors and two patients had large cystic lesions in head, body and tail of pancreas. Median operative time was 431 minutes (range 348-590) with 300 cc (range 150-1200) of blood loss. The 90 days postoperative complication rate of grade 2 or higher Clavien-Dindo classification was 14% and the mortality was 0. Conclusion The laparoscopic hand-assisted total pancreatectomy appears to be a safe and feasible procedure. It is a technically demanding procedure requiring expertise in both open and advanced laparoscopic pancreatic procedures and additional multi-institutional studies are necessary to further evaluate its role.
Sujit Kulkarni, Kaylene Barrera, Rick Selby, Dilipkumar Parekh