Laparoscopic distal pancreatectomy for solid and cystic pancreatic neoplasms: outpatient postoperative management.

BACKGROUND: Laparoscopic distal pancreatectomy is a challenging procedure that has been reported in the last decade. The aim of this study is to describe our experience with laparoscopic distal pancreatectomy and an outpatient postoperative management after an early hospital discharge. METHODS: Retrospective study of 11 laparoscopic distal pancreatectomies carried out at our institution between November 2005 and June 2007 for cystic and solid pancreatic neoplasms. Mean age was 55.5 years and 10 patients were females. A splenopancreatectomy was carried out in 9 cases, and a spleen-preserving resection was carried out in 2 cases. RESULTS: Mean blood loss was 73.6 mL and mean operative time was 238.3 minutes. Patients were able to tolerate regular diet after a mean of 1.2 days and were discharged with a drain after a mean of 2.3 days. Two patients developed a mild pancreatic fistula that resolved with conservative management. One patient developed a pancreatic pseudocyst that was followed up with an MRI. CONCLUSIONS: Laparoscopic distal pancreatectomy is feasible with a fast postoperative recovery. We recommend close follow-up of the patient in the outpatient clinic and maintaining the intraabdominal drain until a pancreatic fistula can be ruled out based on biochemical analysis of the fluid.

Epiphrenic diverticulum: robotic-assisted transhiatal approach.

Surgery of the epiphrenic diverticulum has been related to high postoperative morbidity. Even through a minimally invasive approach, dissection of the neck-proximal portion of the diverticulum can be difficult. Robotic-assisted (RA) technologies have been developed recently. We describe our experience of RA transhiatal diverticulectomy in 2 patients: (1) A 73-year-old female patient who presented with 2 large esophageal diverticula at the mid esophagus and gastroesophageal junction, and a large hiatal hernia. A RA transhiatal diverticulectomy and Nissen fundoplication were performed, although intense adhesions made a limited thoracotomy necessary. The patient developed a mild esophageal leak, which resolved successfully with conservative treatment; (2) A 63-year-old male patient with a large epiphrenic diverticulum, which was resected using the RA transhiatal approach, and a Toupet fundoplication was also performed. The postoperative course was uneventful. We believe that RA transhiatal management of epiphrenic diverticulum can help during the dissection of the proximal portion of the diverticulum and might reduce postoperative morbidity.

Laparoscopic surgery: surgical education in the People's Republic of China: changes after 15 years.

The introduction of laparoscopic surgery education in Mainland China took place in 1991, when Chinese surgeons rushed to the hospital where the first laparoscopic cholecystectomy in the country was performed to learn the keyhole technique; and different groups of surgeons from Western countries visited the land to convey their experience and foresight with their friendship. The situation in laparoscopic surgery and its education has changed a lot in the last 15 years. Communication via conference and workshops are used heavily as a teaching method in laparoscopic surgery education. Technical training is conveyed mainly in laparoscopic centers. Simple simulators created by Chinese surgeons, technical support by the Western forerunners, financial support, and other resources from major companies, and the large population contributed a lot to the fast development of laparoscopic surgery in China.