Laparoscopic management of pancreatic islet cell tumors

Laparoscopy was first used for visual examination of the pancreas in 1911; this was revisited in 1972 where again examination of the pancreas using laparoscopy was suggested (1,2). The advent of laparoscopic ultrasonography (3“5), along with improvement of surgeons’ technical capabilities, have established a new chapter in the diagnosis, staging, and management of unresectable pancreatic carcinoma (6“8). This approach was, however, slow to gain acceptance for resection of malignant pancreatic lesions due to the high morbidity and mortality in operating on this retroperitoneal structure. A new milestone in pancreatic surgery was set by Gagner and Pomp in 1993 (9) when they challenged the surgical field and explored unbroken territories. They performed a laparoscopic pylorus-preserving pancreatoduodenectomy for a patient with chronic pancreatitis localized in the head of the pancreas with pancreas divisum. Although technically feasible, the laparoscopicWhipple procedure did not improve the postoperative outcome or shorten the postoperative recovery period. Attention was then drawn to more benign lesions, including laparoscopic distal pancreatectomy with splenectomy for chronic pancreatitis (10) and laparoscopic resections of islet cell tumors by enucleation or distal pancreatectomy (11). Laparoscopic pancreatic surgery began to gain acceptance and popularity (12) in the mid-1990s. Laparoscopic distal pancreatectomy or enucleation was felt to be technically feasible, safe, and seemed to benefit patients by shortening their hospital stay with no recurrence of disease (11,13“15). Hand-assisted techniques were also attempted with success (16,17). There is a growing worldwide interest in performing laparoscopic enucleation or distal pancreatectomy for islet cell tumors (18“34).