Laparoskopik Pankreas Cerrahisi
Özet
Laparoskopik pankreas cerrahisi, son otuz yılda benign ve malign pankreas hastalıklarının tedavisinde minimal invaziv bir yöntem olarak öne çıkmış; postoperatif ağrının azalması, daha kısa hastanede kalış süresi ve hızlı iyileşme gibi avantajlar sağlamıştır. Başlangıçta tanısal evreleme ile sınırlı olan bu teknik, enstrümantasyon gelişimine paralel olarak pankreas psödokistleri, nekroz drenajı, distal pankreatektomi, enükleasyon ve karmaşık bir prosedür olan pankreatikoduodenektomi (Whipple) gibi alanlarda da uygulanmaya başlanmıştır. Çalışmalar, laparoskopik yaklaşımın açık cerrahiye kıyasla daha düşük intraoperatif kan kaybı ve benzer onkolojik sonuçlar sunduğunu göstermektedir. Ancak bu operasyonlar, ileri düzey laparoskopik beceriler ve açık cerrahi deneyimi gerektiren dik bir öğrenme eğrisine sahiptir. Türkiye'de ilk kez 2019'da gerçekleştirilen laparoskopik Appleby prosedürü gibi kompleks uygulamalar, bu cerrahinin sınırlarını genişletmektedir. Postoperatif yönetimde kan şekeri kontrolü ve dren takibi kritik öneme sahipken, komplikasyon oranları açık cerrahi ile benzerlik göstermektedir. Sonuç olarak, laparoskopik cerrahi seçilmiş hastalarda güvenli ve etkin bir seçenek olarak kabul edilmektedir.
Laparoscopic pancreatic surgery has emerged as a minimal invasive method in the treatment of benign and malignant pancreatic diseases over the last thirty years, providing advantages such as reduced postoperative pain, shorter hospital stays, and rapid recovery. Originally limited to diagnostic staging, this technique has expanded to include pancreatic pseudocysts, necrosis drainage, distal pancreatectomy, enucleation, and the technically demanding pancreaticoduodenectomy (Whipple) procedure alongside advancements in instrumentation. Studies indicate that the laparoscopic approach offers lower intraoperative blood loss and similar oncologic outcomes compared to open surgery. However, these operations involve a steep learning curve requiring advanced laparoscopic skills and experience in open surgery. Complex applications, such as the laparoscopic Appleby procedure first performed in Turkey in 2019, continue to push the boundaries of this field. Postoperative management emphasizes blood sugar control and drain monitoring, with complication rates remaining similar to those of open surgery. Consequently, laparoscopic surgery is considered a safe and effective option for carefully selected patients.
Referanslar
Dulucq. JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20:1045-50.
Nakeeb A. (2013).Laparoscopic Pancreatic Surgery. Josef E. Fischer. Hepatobiliary and Pancreatic Surgery. (41-58). Phlladelphia. LIPPINCOTT WILLIAMS t. WILKINS, a WOLTKKS KLUWER.
Dulucq. JL, Wintringer P, Stabillnf C, et al. Are major laparoscopic pancreatic resections worthwhile? Surg Endosc. 2005;19:1028-1034.
Park A., Schwartz R., at all. Laparoscopic pancreatic surgery. The American Journal of Surgery. 1999;177(2):158-63
Kaistha S., Nandi B., Kumar A. Laparoscopic surgery in pancreatic diseases: Pushing the boundaries. Med J Armed Forces India. 2019 Oct; 75(4): 361–369.
Hagopian EJ, Teixeira JA, Smith M, et al. Pancreatic pseudocyst treated by laparoscopic Roux-en-Y cystojejunostomy. Report of a case and review of the literature. Surg Endosc 2000;14: 967.
Brunschot S, Besselink MG, Boermeester MA, et all. Video-Assisted Retroperitoneal Debritment (VARD) of Infected Necrotizing Pancreatitis: An Up-date. Curr Surg Rep (2013) 1:121-30.
Kerem M. (2019). Laparoskopik Pankreas Cerrahisi. Osman Abbasoğlu. Karaciğer, Safra yolları ve Pankreas Cerrahisi. (373-92).Ankara. Dünya Tıp Kitabevi.
Freeman M.L., Werner J., van Santvoort H.C. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176–1194.
Burdiles P, Rossi RL. Laparoscopy in pancreatic and hepatobiliary cancer. Surg Oncol Clin N Am 2001;10: 531–55.
Rothlin MA, Schob O, Weber M. Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: a case controlled study. Surg Endosc 1999;13: 1065–9.
Van den Bosch R.P., Van der Schelling G.P., Kinkenbijl J.H.G. et al. Guidelines for the application of surgery and endoprosthesis in the palliation of obstructive jaundice in advanced cancer of the pancreas. Ann Surg. 1994; 219: 18-24.
Kooby DA, Hawkins WG, Schmidt CM, at al. A multicenter analysis of distal pancreatectomy fo:r adenocarcinoma: Is laparoscopic resection appropriate? J Am Coll Surg. 2010;210:79-85.
Melotti G, Butturini G, Piccoli. M, at al. Laparoscopic distal pancratectomy results on a consecutive sarles of 58 patients. Ann Surg. 2007;246:77-82.
Nakamura M, Nakashima H.Laparoscopic distal pancreatectomy and pancreaticoduodenectomy. J Hepatobiliary Pancreat SCi 2013; 20:421-28.
Jianwei X, Feng L, Hanxiang Z, et all. Laparoscopic enucleation of pancreatic tumours: a single-institution experience of 66 cases
Li Y, Li F, Liu H, Wang L. Using the root of the mesentery to guide a novel operative approach for laparoscopic insulinoma resection. J. Laparoendosc. Adv. Surg. Tech. A 2016; 26: 557-9.
Marcel ACM, Rodrigo CS, et all. Laparoscopic Central Pancreatectomy: A Review of 51 Cases. Surg Laparosc Endosc Percutan Tech 2013;23:486–490.
Nakeeb A. Laparoscopic pancreatic resections. Adv Surg. 2009; 43:91-102.
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994 May; 8(5):408-10.
Kooby D, Gillespie T, Bt'llltum. D, at al. Left-sided pancreatactomy a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438-446.
Liang S, Hameed U, Jayaraman S. Laparoscopic pancreatectomy: indications and outcomes. World J Gastroenterol. 2014 Oct 21; 20(39):14246-54.
Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, Hughes SJ, Nakamura Y, Vollmer CM, Kooby DA, Asbun HJ, Minimally Invasive Pancreatic Resection Organizing Committee. Minimally invasive pancreatoduodenectomy. HPB (Oxford). 2017 Mar; 19(3):215-224.
Kantor O, Talamonti MS, Sharpe S, et all. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg. 2017 Mar; 213(3):512-515.
Sharpe SM, Talamonti MS, Wang CE, et all. Early National Experience with Laparoscopic Pancreaticoduodenectomy for Ductal Adenocarcinoma: A Comparison of Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg 2015 Jul;221(1):175-84.
Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer. 1953;6(4):704-707.
Klompmaker S, Peters NA, van Hilst J, et al. Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. Ann Surg Oncol. 2019;26(3):772-781.
