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What is Laparoscopic Pancreas Surgery?

Laparoscopic pancreas surgery allows candidate patients to minimize some of the standard risks and discomfort associated with a standard open operation. Laparoscopic surgery is typically performed using 3 or 4 half-inch or one-inch incisions, sparing patients a large incision. Fine surgical instruments are used to carve out a tumor or remove an entire section of the gland, after the nearby blood vessels are controlled.

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The deep and central location of the pancreas in the abdomen, coupled with its "wet sponge" texture, make it a unique organ for surgeons to conquer. Adding to the complexity of pancreas surgery, the pancreas lacks a capsule, or covering, and is thus prone to bleed or leak juices with even a small degree of rough handling. For these reasons, we recommend that pancreas surgery be performed by a specialist who is familiar with standard tissue handling techniques for the pancreas.

Patients who have laparoscopic pancreas surgery report the following benefits:

• Less pain
• Shorter hospitalization
• Lower rates of blood transfusion
• Quicker return to activity and work
• Increased likelihood of preserving the spleen
• Lower rates of wound infections and other complications
• Lower rates of subsequent hernia development
• Minimal scaring

Who is a Candidate for Laparoscopic Pancreas Surgery

Laparoscopic surgery is ideal for tumors of the pancreas tail. Candidacy for laparoscopic removal is determined by one of our surgeons reviewing the patient’s CAT scan images. Patients are encouraged to call the office of Drs. Makary and Edil to arrange for overnight mailing of CAT scan CD-ROM for them to review. Alternatively, a CAT scan can be performed at the Johns Hopkins Hospital on a same-day basis. Typically a repeat CT scan is needed within 1-2 months prior to surgery.

Larger tumors of any part of the pancreas for which an open operation is required can be started laparoscopically to look for cancer spread before making the large incision—sometimes sparing patients the large incision at a time when comfort is the goal.

Drs. Hirose, Makary, Weiss, and Wolfgang perform the operation using standard cancer principles, obtaining a wide enough removal of the pancreas and surrounding tissue to achieve optimal goals for survival, while minimizing the amount of physiologic stress incurred to the patient.

Hirose Kenzo, Marty Makary M.D., M.P.H. , and Christopher Wolfgang

Pancreas and Advanced Laparoscopic Surgery Johns Hopkins Hospital