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Page 10 of 15 Shannon et al. Mini-invasive Surg 2023;7:32 https://dx.doi.org/10.20517/2574-1225.2023.83

Patient selection is important in choosing appropriate candidates for minimally invasive pancreas surgery.
As is the case with all laparoscopic techniques, relative contraindications include a history of prior open
surgery with abundant adhesive disease, which may preclude safe entry into the abdomen, and intolerance
to pneumoperitoneum. Specific to pancreatic disease, pancreatitis or other forms of inflammation may
distort planes and make dissection laparoscopically or robotically very challenging. Additionally, vascular
involvement of tumors in borderline resectable or locally advanced disease may necessitate vascular
reconstruction, which requires additional expertise to perform in a minimally invasive fashion. As a result,
benign or low-grade malignant lesions without vascular lesions, such as neuroendocrine tumors, cystic
lesions, and tumors of the ampulla of Vater, are best suited to minimally invasive PD [110,111] . A final
consideration in appropriate candidates for minimally invasive pancreas surgery is body habitus. While
obesity or thinness is not a contraindication, it presents unique challenges. In obese patients, the extra- and
intra-abdominal adipose tissue can make finding appropriate planes challenging, whereas extremely thin
patients may preclude adequate spacing of trocars to allow for a full range of motion.

While attempting to assess the most up-to-date, level 1 data regarding minimally invasive pancreatectomy,
there are some limitations to the studies discussed above. Firstly, there may be inherent selection biases in
some of the studies. Patients undergoing laparoscopic or robotic pancreatectomy would likely have
differences in tumor size, malignant features, and vessel involvement, which could lead to more extensive
surgery such as portal vein reconstruction. Additionally, patients with a more extensive history of
abdominal surgery may not be ideal candidates for minimally invasive approaches.

While this review focused exclusively on minimally invasive PD and DP, there are current studies showing
promising outcomes for minimally invasive central and total pancreatectomy as well, which will be an area
of future research [112,113] .

CONCLUSION
Overall, minimally invasive pancreatic resection remains a complex and technically challenging procedure
that has seen significant improvement in morbidity and mortality over time and has been shown to be safe
and efficacious in certain well-selected patient populations compared to open approaches. As the advent of
minimally invasive approaches has been increasingly utilized for other abdominal or thoracic operations,
laparoscopic and robotic techniques are slowly being adopted for pancreatic surgery. Several retrospective
and a limited number of prospective studies support the use of minimally invasive pancreatic surgery in
experienced centers. These benefits include a faster time to recovery, reduced pain, and shorter length of
hospital stay following surgery. However, it is important to note that there are disadvantages, such as
increased operative time and cost. Despite these promising results, additional data on long-term oncologic
outcomes and survival are still needed for patients undergoing both PD and DP for cancer. Future planned
and ongoing randomized studies will provide additional clarification regarding the safety and efficacy of
minimally invasive pancreatic surgery.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and writing of the manuscript: Shannon A, Bath NM,
Ejaz A

Availability of data and materials
Not applicable.