Laparoscopic pancreatectomy (removal of portion of pancreas)

A. The Condition. You may have a tumor of the pancreas. The treatment for pancreatic tumors often includes surgical removal.

B. Symptoms

• Nausea, vomiting
• Jaundice
• Abdominal pain
• Weight loss, weakness

C. Laparoscopic Pancreatectomy. The surgeon will make about 4-5 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the portion of the pancreas which contains the tumor. The pancreas is closely positioned to may other organs, such as the duodenum, stomach, colon, spleen, and major blood vessels. This operation can require many hours to complete because of its complexity. The pancreas is cut out with surgical staplers. The pancreas specimen then is removed from your abdomen by enlarging one of the small incisions. Sometimes a small rubber drain is placed at the surgery site inside your abdomen, and this exits from your skin. After all this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. Sometimes your problem may be treated with chemotherapy. Your doctor will discuss with you what your best option is.

E. Risks. The primary risks of laparoscopic pancreatectomy are:

• Infection of the skin at one of the small ports sites
• Leakage of pancreatic juice at the surgical site
• Collection of pus inside your abdomen (intraabdominal abscess)
• Postoperative ileus (the intestines slow down/stop working for several days)
• Small bowel obstruction (kinking of the small bowel, causing blockage)

F. Expectations

1. Before Your Operation. Laparoscopic pancreatectomy usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, endoscopy (looking down your throat with a scope), an abdominal CT scan, and perhaps a nuclear medicine scan. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 2-5 days after a laparoscopic pancreatectomy. You may need to wait until your bowels start working. You will be given medication for pain, and you may be given antibiotic pills. If you have a drain in place, then your doctor and/or nurse will instruct you in its care. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• High fever
• Severe abdominal pain
• Odor or increased drainage from your incision
• Jaundice
• No bowel movements for three days

G. Pertinent References

Bilimoria MM, Frantzides CT, Laguna LE. “Minimally Invasive Distal Pancreatectomy.” In: Frantzides CT, Carlson MA, eds. Atlas of Minimally Invasive Surgery. Philadelphia: Saunders Elsevier, 2009.