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- Title
Laparoscopic Enucleation of Benign Pancreatic Tumours.
- Authors
PUIA, Ion C.; PUIA, Aida; CRISTEA, G.
- Abstract
Benign pancreatic tumour enucleations have been performed since 1996. Endocrine tumours (ET) are rare yet they represent about 2/3 of the laparoscopic enucleations, a topic still in debate. The preoperative imaging routinely comprises a CT scan, but endoscopic ultrasound is mandatory for localizing the tumour and guided biopsy-aspiration. Trocars have to be positioned to avoid "fencing" with the instruments. A Kocher procedure may be necessary for accessing deep or posterior tumours. The bipolar electrocautery and harmonic scalpel ensure better haemostasis than the monopolar cautery hook. The raw surface can be covered with haemostatics or fibrin glue. The mean operating time is about two hours. Forced conversions, due mainly to haemorrhage or insufficient exposure, are uncommon (9%). Pancreatic fistula, the main postoperative complication, .affects up to one third of the patients and does not depend on the choice of dissection instruments, management of the remaining cavity or somatostatin use. The main risk factor is the location of the tumour at less than 2 mm from the main pancreatic duct. The necrotic pancreatitis, the pancreatic [pseudocyst and the duodenal fistula contribute to a surgical morbidity up to 60%. Although safe and technically feasible, enucleation might be considered as a procedure with high morbidity score.
- Subjects
CELL enucleation; PANCREATIC cancer; CELL nuclei; ENDOCRINE gland cancer; TUMORS
- Publication
Notulae Scientia Biologicae, 2016, Vol 8, Issue 4, p393
- ISSN
2067-3205
- Publication type
Article
- DOI
10.15835/nsb849932