**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**


Because cancer cell invasion is dependent on protease activity, Gerota's fascia may function

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.

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

Appu, S.; Young, A.B. & Lawrentschuk, N. (2005). Peritoneal "pillowcase" for the displaced

Dexter, S.P.; Martin, I.G.; Leindler, L.; Fowler, R. & McMahon, M.J. (1999).Laparoscopic

Fagniez, P.L. & Munoz-Bongrand, N. (1999), Vascular control during left

Gagner, M. & Pomp, A. (1994), Laparoscopic pylorus-preserving pancreatoduodenectomy.

Gagner, M.; Pomp, A. & Herrera, M.F. (1996), Early experience with laparoscopic resections

Hama, T.; Takifuji, K.; Uchiyama, K.; Tani, M.; Kawai, M. & Yamaue, H. (2008),

Hirota, M.; Shimada, S.; Yamamoto, K.; Tanaka, E.; Sugita, H.; Egami, H. & Ogawa, M.

Hirota, M.; Kanemitsu, K.; Takamori, H.; Chikamoto, A.; Ohkuma, T.; Komori, H.;

spleen post-distal pancreatectomy. Journal of Hepatobiliary Pancreatic Surgery,

enucleation of a solitary pancreatic insulinoma. Surgical Endoscopy, Vol.13, pp.

splenopancreatectomy in cancer. Annales de Chirurgie, Vol.53:, pp. 632-634, (in

Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension. Journal of Hepatobiliary Pancreatic

(2005), Pancreatectomy using the no-touch isolation technique followed by extensive intraoperative peritoneal lavage to prevent cancer cell dissemination: a

as a barrier against protease-mediated invasion of cancer cells.

are useful measures to prevent post-operative complications.

**5. Conclusion** 

**6. References** 

Vol.12, pp. 470-473.

French with English abstract).

Surgery, Vol.15, pp. 304-309.

pilot study. JOP, Vol.6, pp. 143-151.

Surgical Endoscopy, Vol.8, pp. 408-410.

of islet cell tumors. Surgery, Vol.120, pp. 1051-1054.

406-408.


**Laparoscopic Liver Surgery** 

Warshow, A.L. (1988), Conservation of the spleen with distal pancreatectomy. Archives of Surgery, Vol.123, pp. 550-553. **Part 2**  Surgery, Vol.123, pp. 550-553. **Part 2** 

**Laparoscopic Liver Surgery** 

60 Updated Topics in Minimally Invasive Abdominal Surgery

Warshow, A.L. (1988), Conservation of the spleen with distal pancreatectomy. Archives of

**5** 

**Laparoscopic Liver Resection** 

Since the introduction of the laparoscopic cholecystectomy, there has been explosive growth in the field of minimally invasive surgery. Commonly accepted laparoscopic procedures have now come to include bariatric and anti reflux procedures, distal pancreatectomy, splenectomy, hernia repair, and colon resection. The adoption of laparoscopy to the field of liver surgery; however, has been slower to take off. Initial concerns included inadequate exposure and ability to attain hemostasis, fear of gas embolism, and doubts over the oncologic adequacy of the less invasive procedure. The earliest reports of laparoscopic liver surgery were limited to wedge resections for staging or isolated metastases(Lefor, AT & Flowers, JL 1994). Laparoscopic liver resection finally started to gain serious widespread attention after publication of Cherqui's initial thirty patient experience(Cherqui, D et al 2000). Since that time, the field has seen explosive growth, with over 2,804 cases now described in the world literature(Nguyen, KT et al 2009). Despite its widespread acceptance, laparoscopic liver resection remains a daunting technical challenge suited to a relatively small number of centers that have taken the time and effort to develop concurrent expertise in both open hepatic surgery and laparoscopy. Once these hurdles are overcome; however, laparoscopic liver resection is a safe and highly effective procedure offering numerous patient benefits. In this chapter, we will describe the indications for laparoscopic liver resection, and outline the steps that should be taken by fledgling groups wishing to embark

Benign liver tumors represent a diagnostic and therapeutic challenge. Traditionally, a highly conservative approach to benign hepatic tumors has been favored, owing to the historically high morbidity and mortality associated with open liver surgery. As operative and anesthetic techniques have improved, these hurdles have come down. Despite the increased safety of hepatic surgery, the indications for resection of benign hepatic tumors have changed little: symptomatic lesions, asymptomatic lesions at high risk of rupture or malignant degeneration, and inability to exclude malignancy nonoperatively. Because of concerns over oncologic adequacy, benign lesions represent the ideal starting point for a laparoscopic liver surgery program. Despite the attractiveness of minimally invasive surgery; however, surgeons should be cautioned that the ability to perform a laparoscopic

**1. Introduction** 

**2. Benign disease** 

upon creating a laparoscopic liver resection program.

resection should not change the indications for operation.

Robert M. Cannon1 and Joseph F. Buell2 *1University of Louisville Dept of Surgery, 2Tulane University Dept of Surgery* 

*United States of America* 
