How may the surgery be performed? The surgery is traditionally performed by an open operation through an incision that often spreads across both sides of the upper part of the abdomen.
More recently, pancreas tumours have been removed safely by ‘keyhole’ (laparoscopic) surgery. Not all tumours/cysts though can be removed by laparoscopic surgery, and your scans will help us determine whether your tumour/cyst is suitable.
Laparoscopic surgery is carried out through a few small cuts on the abdomen, and with the use of gas (carbon dioxide) to inflate the abdomen. The operation is then performed using a special telescope and special instruments. Sometimes one of the cuts is made longer than others in order for the surgeon to place one hand in the abdomen to help with the surgery (this is called ‘hand-assisted laparoscopic surgery’) and through which the surgeon finally removes the resected part of the pancreas.
In principle, the laparoscopic distal pancreatectomy is the same as the open operation, but is performed through smaller cuts. Whenever we do a laparoscopic operation, however, there is a chance that we may need to convert to a traditional open operation if faced with a difficulty that we cannot overcome by laparoscopic surgery. The chance of a conversion to open surgery may be as high as one-in-five patients (or 20%).
What are the risks of the open operation?
Pancreas resection is major surgery and, like other major operations, carries a risk to life and risk of complications. Almost one-of-four patients (25%) may have a complication after the surgery that delays their discharge from hospital. These may include complications ‘specific’ to the pancreas surgery and ‘general’ complications.
The specific complications may include bleeding, leakage from the pancreas (pancreatic leak or fistula), or collection of infected fluid at the site of the removed pancreas (abscess).
General complications of any surgery may include wound infection, chest infection, urine infection, fluid collection on the chest (pleural effusion), heart problems, or clots in the legs (deep vein thrombosis; DVT). If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months or years later.
The risk of death due to a complication is 5% or one chance in twenty. Most people having open surgery will be in hospital for two to three weeks.
What are the benefits of the ‘keyhole’ surgery?
‘Keyhole’ (laparoscopic) surgery involves smaller cuts, requires only minimal tissue handling and causes less trauma to adjacent normal organs. Hence, it usually results in considerably less pain after the surgery, which makes it easier and quicker for you to get up and about after the operation. As you become mobile earlier, you may have less chance of getting some of the general complications of surgery. You may therefore be able to go home quicker (average 4-7 days) and get back to your normal activity sooner.
What are the risks of the ‘keyhole’ surgery?
The ‘specific complications’ of pancreas resection that were mentioned above, such as bleeding, pancreatic leak, or abscess remain the same after laparoscopic surgery as these complications relate to the fact that you’ve had a pancreas resection. Rarely, one might accidentally make a hole in the bowel when putting the first port (a ‘port’ is a short tube through which the surgeon passes instruments into the abdomen to do the surgery) in the abdomen. The chance of that is less than one in 300; and this is something that we can repair laparoscopically. In all laparoscopic surgery there is a very small risk of gas entering the blood stream causing a problem with the circulation, which is treatable. To make this complication less likely we use low pressure gas.
How experienced are we with keyhole surgery?
There has been some 70 such operations performed worldwide, and the results suggest favourable benefits to the patients. Our experience with laparoscopic distal pancreatectomy at Manchester Royal Infirmary is currently limited to two patients. The procedures were completed laparoscopically without a need to convert to an open operation, and both patients made uneventful recovery. Although our experience with laparoscopic pancreatic resection is -at present- limited, we have a good experience in complex laparoscopic surgery, and take all the safety precautions needed to make your operation go as smoothly as possible.
