Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy

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Abstract
As laparoscopic instruments have become more refined and advancements in robotic platforms have allowed for improved ergonomics and more controlled movements, the applications of minimally invasive surgery have greatly expanded. The evolution of minimally invasive pancreatic surgery, however, has been relatively slow in gaining traction. Indeed, while the first reports of laparoscopic pancreatic surgery were published in 1994,1-3 the vast majority of the literature on this topic has been published in only the past 5 to 10 years and consists primarily of single-institution/surgeon experiences,4-9 multi-institutional case series,10-13 and meta-analyses based thereupon.14-17 This delay in the widespread adoption of minimally invasive techniques in the treatment of pancreatic disease was likely engendered, at least in part, by the inherent technical challenges presented by the retroperitoneal location and notoriously unforgiving nature of the pancreas, close proximity to major vascular structures, and early concerns regarding oncologic outcomes.13,18 While results from existing series are promising, they have been limited in their generalizability and interpretation by their sample size and variable practice setting. A broader investigation into this topic is therefore warranted.