| セッション情報 | 招待講演(消化器外科学会)Laparoscopic pancreato-biliary surgery, present and future directions |
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| タイトル | 招待講演5：Laparoscopic pancreato-biliary surgery, present and future directions |
| 演者 | M. L. Kendrick（Mayo Clinic） |
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| 抄録 | Minimally invasive approaches are increasingly utilized in pancreaticobiliary surgery. Large institutional series and several meta-analysis have now validated the advantages of laparoscopic approaches for distal pancreatectomy including, less blood loss and wound morbidity as well as shorter hospital stay. Wide-spread utility of this approach is increasing and it is now performed at most specialized centers. The specific technical aspects of minimally invasive distal pancreatectomy vary by surgeon preference. The number and position of trocars, method of pancreatic transection and treatment of the pancreatic stump vary considerably amongst surgeons with no one technique demonstrating superiority over another. Current experience with laparoscopic distal pancreatectomy has predominantly focused on benign and premalignant conditions although several centers have reported outcomes with malignancy. These preliminary reports are encouraging and suggest that minimally invasive approaches can provide similar oncologic outcomes as for the standard open approach. Pancreaticoduodenectomy requires a much more complex dissection and adds the challenge of reconstruction compared to distal pancreatectomy. As a result, few published series of laparoscopic pancreaticoduodenectomy exist; currently less than 10 institutions have reported experience in more than 50 patients. While these series suggest comparable outcomes to open approaches, small numbers and patient selection bias, limit a clear validation of this approach to date. Indications for minimally invasive approaches have included patients with malignancy in most published series. Surrogates of oncologic resection such as number of lymph nodes harvested, margin status, and short-term outcomes suggest oncologic outcomes comparable to those reported for open approaches. Major venous resection is indicated in a subset of patients undergoing pancreaticoduodenectomy and laparoscopic approaches have been reported to be safe and feasible in selected patients. Robotic-assisted laparoscopic approaches for pancreaticobiliary surgery have also been reported. Current evidence is lacking to clearly validate advantages of robotics over pure laparoscopy with regard to patient outcomes. Perhaps the greatest advantage may be to provide opportunity for surgeons without advanced laparoscopic skills to offer minimally invasive approaches to their patients. The current status of minimally invasive approaches in pancreaticobiliary disease is encouraging and is expected to improve patient outcomes. Future directions include optimal training opportunities and the evaluation of robotic assisted laparoscopic approaches. |
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