ABSTRACT
Laparoscopy was first used for visual examination of the pancreas in 1911; this was revisited in 1972 where again examination of the pancreas using laparoscopy was suggested [1, 2]. The advents of laparoscopic ultrasonography [3–5], along with improvement of surgeons’ technical capabilities, have established a new chapter in the diagnosis, staging, and management of unresectable pancreatic carcinoma [6–8]. This approach was, however, slow to gain acceptance for resection of malignant pancreatic lesions due to the high morbidity and mortality in operating on this retroperitoneal structure. I set a new milestone in pancreatic surgery in 1992 for laparoscopic distal pancreatectomy [73], and a year later, in 1993, for laparoscopic Whipple [9], when the surgical field was challenged and led to explore unbroken territories. I performed, more specifically, a complete laparoscopic pylorus-preserving pancreatoduodenectomy for a patient with chronic pancreatitis localized in the head of the pancreas with pancreas divisum. Although technically feasible, the laparoscopic Whipple procedure did not improve the postoperative outcome or shorten the postoperative recovery period at that time, with limited staplers, early hand-sewn techniques, and limited energy sources. It appears that instrumentation improvements of the last decade have permitted us to see a gain in laparoscopic pancreatiduodenectomy, provided that no complications occur. Attention was then drawn to more benign lesions, including laparoscopic distal pancreatectomy with splenectomy for chronic pancreatitis [10], and laparoscopic resections of islet cell tumors by enucleation or spleen-preserving distal pancreatectomy [11]. Laparoscopic pancreatic surgery began to gain acceptance and popularity [12] in the mid-1990s. It has been proved to lessen the stress response of individuals needing pancreatic resection [69]. Laparoscopic distal pancreatectomy or enucleation was felt to be technically feasible and safe, and seemed to benefit patients by shortening their hospital stay with no recurrence of disease [11, 13–15, 70, 71, 81, 82, 96]. Hand-assisted techniques and robotic assistance in small numbers were also attempted with success [16, 17, 81]. There is growing worldwide interest in performing laparoscopic enucleation or distal pancreatectomy for islet cell tumors [18–34, 71].
