At USC we have used new technology and advanced laparoscopic techniques to develop new laparoscopic operations for pancreas, liver and bile duct diseases. New laparoscopic hand-access devices allows the surgeon to place a hand into the abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery.
Dilip Parekh M.D. at USC has utilized this new device to develop laparoscopic surgical procedures such as the Whipple operation, distal pancreatectomy and liver resection.
Benefits of minimally invasive or laparoscopic procedures include less post operative discomfort since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars.
Furthermore, there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.
The laparoscopic procedures performed on the pancreas at USC are:
Diagnostic and exploratory laparoscopy in patients with cancer of the pancreas
It is estimated that 10 to 15% of all patients who are thought to have cancer confined to the pancreas on preoperative x-ray studies including CT scan are shown to have metastatic disease at the time of surgery. To avoid unnecessary open surgery we perform a diagnostic laparoscopic procedure before making a large open incision. A complete examination of the abdomen is performed to rule out the presence of metastatic disease. The patient will undergo open surgery for removal of the pancreatic cancer, if the diagnostic laparoscopic examination is normal.
We offer laparoscopic distal pancreatectomy for endocrine and cystic tumors of the body and tail pancreas. Endocrine 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 2.5 to 3 inches long.
The hand-access devices are a major advancement in laparoscopic surgery and allows the surgeon to place his/her 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 laparoscopic Whipple operation. At present this procedure may be performed laparoscopically at USC in selected patients with chronic pancreatitis, and small 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 a hand-access device. Patients usually have three half inch incisions and a hand-access device incision that is approximately 2.5 to 3 inches long.
Central pancreatectomy is a complex operation performed on the pancreas by only a few surgeons in the USA for patients with a pancreatic tumor in the neck of the pancreas. The procedure provides localized removal of the tumor with 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.
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.
Some of the complications that patients with severe pancreatitis develop include pancreatic necrosis (dead pancreas) that requires removal, pancreatic abscesses and infections that often occur in areas of dead pancreas and pseudocysts which are localized collections of pancreatic enzymes due to an injury to the pancreatic duct from the pancreatitis.
Pancreatic pseudocysts are localized collections of pancreatic fluid that has leaked out of the pancreatic duct and developed into a local swelling behind the stomach. The pseudocyst may give rise to pain, nausea and blockage of the stomach or the duodenum. The treatment is to drain the cyst into a attached organ structure such as the stomach or the intestine. We provide a specialize laparoscopic procedure for treatment of pancreatic pseudocysts.
The Peustow operation is performed in patients with severe pain from chronic pancreatitis. In this procedure the pancreatic duct that is blocked by inflammation of chronic pancreatitis is opened and sutured into the intestine. This allows the pancreatic secretions that were previously blocked to drain into the intestine. At USC we offer a specialized procedure utilizing advance laparoscopic techniques to perform the Peustow operation by a laparoscopic operation.
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