Minimally Invasive Pancreatectomy - Indications, Contraindications, Procedure, and Complications

Introduction

The pancreas is an organ in the human body located in the abdomen that produces various hormones and enzymes. Multiple conditions may damage the pancreas, such as cancer, inflammation, infection, and so on. Its main function is to produce hormones and enzymes that help in regulating blood sugar levels.

When conventional therapies fail to treat the pancreas-related disease or condition, surgical removal of the organ is indicated. Traditionally, it is done through open surgery. However, nowadays, minimally invasive techniques have been developed that are widely used, such as laparoscopic pancreatectomy, robotic pancreatectomy, and many more.

What Is Pancreatectomy?

It is the surgical procedure to remove a diseased part or entire pancreas from the human body.

What Is Minimally Invasive Distal Pancreatectomy?

It is a minimally invasive surgical removal of the distal part of the pancreas, which includes the tail and body of the pancreas.

Why Might Someone Need a Pancreatectomy?

Healthcare providers most commonly recommend a pancreatectomy due to tumors or pancreatitis. Tumors pose a risk of spreading to other parts of the body, so removing them from the pancreas helps mitigate this risk. Pancreatitis, an inflammation of the pancreas, can cause severe pain and other complications, sometimes necessitating a pancreatectomy.

What Are the Types of Pancreatectomy?

1. Distal Pancreatectomy: The tail and body of the pancreas are removed surgically. Sometimes, the spleen is also removed.

2. Total Pancreatectomy: The entire pancreas, pancreatic duct, and a part of the stomach is removed.

What Are the Indications of Pancreatectomy?

The indications of total pancreatectomy are:

• Tumors in which the head of the pancreas is diseased.

• When the surgeon fails to obtain cancer-free margins of the pancreas.

• When the surgeon fails to join the two ends of the pancreas surgically after removing the duodenum and a part of the pancreas.

• Recurrent cancer of the pancreas.

• Bleeding from the pancreas is a complication.

• A patient who has a family history of pancreatic cancer.

• Severe pain because of inflammation of the pancreas.

The indications of distal pancreatectomy are:

• Benign or harmless cancer of the pancreas involves the body and tail.

• Chronic inflammation in the body and tail of the pancreas.

• Formation of cyst-like structure in the tail of the pancreas.

• Fistula formation.

What Are the Contraindications of Pancreatectomy?

• Presence of medical illness or other conditions.

• Coagulopathy (a bleeding disorder in which the blood clot is not formed).

• Highly obese patients.

• Patients with a history of major surgery on their abdomen.

• Cancer of the pancreas in which the doctor cannot remove all the diseased parts.

• Involvement of vascular structures.

What Are the Preparations Before a Pancreatectomy?

In the days leading up to the pancreatectomy, individuals may need to take several preparatory steps:

• Testing: Individuals will meet with a nurse practitioner for presurgical testing. They will review the medical history and current medications. Individuals may also undergo standard medical tests, such as a chest X-ray or EKG, to ensure they are in good health for the surgery.

• Quitting: The nurse will inquire about the alcohol use. It is crucial to be honest, as alcohol can cause complications during and after surgery. The healthcare team can help individuals stop safely and manage any withdrawal symptoms if necessary.

• Medications: Individuals may be given an antiseptic skin cleanser to use before the procedure to prevent bacterial infections. Additionally, they might need to stop taking certain medications, such as blood thinners and NSAIDs, several days before the surgery.

How Is Pancreatectomy Done?

The pancreatectomy is done through two techniques:

1. Open Pancreatectomy -

• General anesthesia is given to the patient.

• An incision or cut is made in the patient's abdomen. Generally, the incision is made through the skin and tissues and crosses the midline of the stomach.

• The abdomen is exposed, and the internal structures are retracted using various retractors such as Omni-tract, Bookwalter, and others.

• The pancreas is exposed. Depending on the type of pancreatectomy, total or distal, the part of the pancreas or complete pancreas is cut and removed.

2. Laparoscopic Pancreatectomy -

• It is a minimally invasive procedure.

• General anesthesia is given to the patient.

• Multiple incisions, generally four to five incisions, are made on the patient's abdomen. These incisions are made at different locations.

• A camera is inserted through one incision.

• Instruments are inserted through another incision.

• With the help of the camera, the surgeon visualizes the internal organs and locates the pancreas.

• The pancreas is cut and removed.

What Are the Patient Selection Criteria for Minimally Invasive Pancreatectomy?

The following factors play an essential role in planning pancreatectomy:

• Experience of the surgeon.

• The overall health of the patient.

• History of previous major surgery.

• Fat distribution in the patient’s body (body mass index).

What Are the Advantages of Minimally Invasive Pancreatectomy?

• It preserves the surrounding healthy tissues.

• Fast recovery time.

• Less scarring or scar formation.

• Less bleeding during and after surgery.

• Low risk of complications after surgery.

What Are the Complications of Minimally Invasive Pancreatectomy?

In general, the complications after pancreatectomy are the same as any standard surgical procedure, such as:

• Fistula Formation - The chances of fistula development are up to 60 % after surgery. A fistula is an abnormal connection between two structures or organs.

  • Compromised blood supply of the spleen results in necrosis and tissue death. This is called splenic infarction.

  • Slowing of the food movement in the stomach. This is called delayed gastric emptying.

  • Leakage in an anastomosis (a connection created surgically between two ends of an organ).

  • Excessive internal bleeding between the organs in the abdomen results in intra-abdominal hemorrhage.

  • Infection in the wound or surgery site.

Will the Person Develop Diabetes After a Pancreatectomy?

Individuals might develop diabetes after a pancreatectomy. Since the pancreas produces natural insulin, removing a significant portion of it could make them reliant on insulin therapy. However, with a partial pancreatectomy, some insulin-secreting cells remain, which might be sufficient. If individuals are undergoing a total pancreatectomy, they will likely develop diabetes unless their surgeon can preserve some insulin-producing cells. This depends on the specific condition. In some cases, the surgeon can transplant these cells into the liver.

Conclusion

Minimally invasive pancreatectomy is a widely used surgery over traditional pancreatectomy because of its various advantages. It is indicated in several conditions, such as tumors of the pancreas, severe inflammation, and many others. However, multiple factors related to the doctor and the patient play an essential role before planning the surgery. In addition, it is a highly complicated surgery that requires advanced skills and an appropriate approach.