Background: Minimally invasive distal pancreatectomy (MIDP) was initially performed for benign tumors, but recently its indications have steadily broadened to encompass other conditions including pancreatic malignancies. Thorough anatomical knowledge is mandatory for precise surgery in the era of minimally invasive surgery. However, expert consensus regarding anatomical landmarks to facilitate the safe performance of MIDP is still lacking. Methods: A systematic literature search was performed using keywords to identify articles regarding the vascular anatomy and surgical approaches/techniques for MIDP. Results: All of the systematic reviews revealed that MIDP was not associated with an increase in postoperative complications. Moreover, most showed that MIDP resulted in less blood loss than open surgery. Regarding surgical approaches for MIDP, a standardized stepwise procedure improved surgical outcomes, including blood loss, operative time, and major complications. There are two approaches to the splenic vessels, superior and inferior; however, no study has ever directly compared them with respect to clinical outcomes. The morphology of the splenic artery affects the difficulty of approaching the artery's root. To select an appropriate dissecting layer when performing posterior resection, thorough knowledge of the anatomy of the fascia, left renal vein/artery, and left adrenal gland is needed. Conclusions: In MIDP, a standardized approach and precise knowledge of anatomy facilitates safe surgery and has the advantage of a shorter learning curve. Anatomical features and landmarks are particularly important in cases of radical MIDP and splenic vessel preserving MIDP.
|Number of pages||10|
|Journal||Journal of Hepato-Biliary-Pancreatic Sciences|
|Publication status||Published - 2022 Jan|
Bibliographical noteFunding Information:
This review was performed in preparation for the “Precision Anatomy for Minimally Invasive Hepato-Biliary-Pancreatic surgery; Expert Consensus Meeting,” which will be held during the 32nd annual meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery in Tokyo in February 2021. Details on the design of this project were decided by Masafumi Nakamura, Takao Ohtsuka, Yuichi Nagakawa, Daisuke Ban, Kohei Nakata, Hitoe Nishino, Akihiko Tsuchida, and Itaru Endo. Hitoe Nishino contributed to the progress of this project as the secretariat. The literature was searched and reviewed by Giovanni Maria Garbarino, Yoshiya Ishikawa, Aya Maekawa, Yoshiki Murase, and Daisuke Ban. The draft of the manuscript was critiqued by Masafumi Nakamura, Takao Ohtsuka, Yuichi Nagakawa, Daisuke Ban, Goro Honda, Jin-Young Jang, Chang Moo Kang, Anusak Yiengpruksawan. All authors approved the final manuscript.
© 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery
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