Laparoscopic surgery for endocrine tumors
Advanced laparoscopic techniques are being developed at USC for treatment of endocrine tumors of the abdomen. Laparoscopic surgery is a major advance for the treatment of endocrine tumors of the adrenal gland and the pancreas. Laparoscopic surgery is feasible for endocrine tumors of the pancreas and the adrenal gland since the majority of these tumors are benign (non-cancerous).
Patients who undergo laparoscopic surgery have small incisions associated with much less pain compared the large open incision that are required for open surgery. Early postoperative recovery, early discharge from hospital and much more rapid return to normal function. Most patients return to work earlier after laparoscopic procedures compared open procedures.
Since the adrenal gland and the pancreas are located deep in the abdomen the surgical incisions for open surgery are long and large incisions. These incisions are usually associated with a lot of discomfort and require recovery period of 4 to 12 weeks. The majority of patients who undergo open surgery stay in hospital for 4 to 10 days after surgery compared to patients who undergo laparoscopic surgery and stay in hospital for 1 to 3 days after surgery.
Laparoscopic surgery for endocrine tumors of the abdomen require expertise in advanced laparoscopic techniques and should be performed in specialized centers that do a high volume of these procedures for the best possible outcome. While laparoscopic adrenal surgery is performed at many centers in the United States, laparoscopic pancreatic surgery is performed in very few centers in the United States.
Laparoscopic procedures are offered at USC for treatment of endocrine tumors of the pancreas and the adrenal gland.
The procedure of removal of an adrenal gland is called an adrenalectomy. There are two adrenal glands in the body on the right and left sides. The adrenal gland may be removed on one side or both sides at the time of surgery depending on the nature of disease.
Laparoscopic adrenalectomy is the procedure of choice for benign (non-cancerous) adrenal tumors. Laparoscopic surgery has proved to be a major advancement for the management of adrenal tumors. Patients that have undergone laparoscopic adrenal surgery have much shorter hospitalization (the average hospitalization after a laparoscopic procedure is one to two days compared to five to seven days after an open procedure), more rapid recovery (approximately 2 weeks compared to 4 to 8 weeks after open surgery) and earlier return to work. The postoperative pain is markedly reduced after laparoscopic surgery and the general feeling of physical well being returns at a much faster rate.
At USC we offer specialized expertise in laparoscopic adrenalectomy. We perform the procedure utilizing both standard laparoscopic techniques and newer laparoscopic procedures with a hand-access device that allows assistance during laparoscopic surgery of the human hand.
Common indications for laparoscopic removal of the adrenal gland are the following:
Laparoscopic surgery for pancreatic islet cell tumors
Enucleation of pancreatic islet cell tumors
Many functional pancreatic islet tumors such as insulinoma and gastrinoma are small tumors usually less than 1 to 2cm. Furthermore the tumors are often on the surface of the pancreas. The tumors have a lining around them that separates them from the pancreas.
An operation called enucleation is often performed for these tumors. In this operation the tumor is shelled out from the pancreas without removing any pancreatic tissue. We have developed a laparoscopic technique for this operation. This procedure avoids the operations described below which are longer associated with removal with of pancreatic tissue and require longer periods of recovery.
Laparoscopic enucleation of a pancreatic islet cell tumor also allows rapid recovery, early discharge from hospital and early return to work.
We offer laparoscopic distal pancreatectomy for neuroendocrine tumors and cystic tumors of the body and tail pancreas. Neuroendocrine and cystic tumors of the pancreas are associated with an excellent outcome and are often benign or associated with a very low grade malignancy. During this procedure two half inch incisions are made and a hand-access device is utilized to perform the surgery. The hand-access device incision is about 2 to 2.5 inches long.
Hand-access devices are a major advancement in laparoscopic surgery and allows the surgeon to place a hand into the abdomen during the surgical procedure. Patient who undergo laparoscopic distal pancreatectomy have less pain, rapid recovery and early discharge from the hospital compared to open distal pancreatectomy. Our average hospital stay for this procedure is about two days.
At USC, Dilip Parekh M.D. is developing techniques for a whipple operation. At present this procedure is performed laparoscopically at USC in patients with chronic pancreatitis, cystic and endocrine tumors of the pancreas and patients who have ampullary cancer. We do not offer the laparoscopic Whipple operation for pancreatic cancer. The Whipple operation is performed laparoscopically utilizing the handport device. Patients will have three half inch incisions and a hand-access device incision that is approximately 2 to 2.5 inches long.preservation of the body and tail of the pancreas that would otherwise be removed as part of the distal pancreatectomy that is usually performed for these tumors. In selected patients we offer a laparoscopic approach for this procedure.
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