Minimally invasive surgery for pancreatic diseases

When it comes to gallbladder stones and cholecystitis, when surgical treatment is needed, most people think of minimally invasive keyhole surgery, because only three small holes of 0.5~1.0cm are needed to remove the gallbladder, and you can get out of bed after a few hours of surgery, and you can eat and go home the next day after surgery, compared to traditional open cholecystectomy: you need to be hospitalized for 7 days to remove the stitches, and you can eat only on the 3rd~4th day after surgery. In contrast, a large incision brings not only pain, but also damage to tissues from the large incision, and the impact on other organs from the pulling and compression during open surgery. Therefore, minimally invasive keyhole surgery has been widely accepted by patients and physicians, and gallbladder removal is unobjectionably accepted with minimally invasive laparoscopic surgery. Laparoscopic surgery originated in Europe more than 20 years ago, and with the development of technology, laparoscopic surgical instruments and auxiliary surgical equipment have become more and more complete, and now there is a 3D robotic surgical system that is more flexible than laparoscopy, and laparoscopic surgery has also changed from simple cholecystectomy and appendectomy to laparoscopic radical surgery for colorectal cancer and gastric cancer, and laparoscopic radical surgery for colorectal cancer has been That is to say, when a colorectal cancer patient comes to the hospital, the doctor’s first choice should be to perform laparoscopic surgery on him, unless the patient’s health and tumor condition do not allow it. However, in the field of pancreatic disease treatment, the development of laparoscopic technology has been unsatisfactory. The main reason is due to the special location of the pancreas in the human body and the special nature of pancreatic diseases. The pancreas is located in the upper part of our abdominal cavity, and most of the pancreas is behind the stomach, that is, it is in the deep posterior peritoneal surface of the abdominal cavity, and it is surrounded by numerous large blood vessels, and these vessels are not the vessels that are specifically supplying the pancreas, so that when doing pancreatic surgery, the pancreas should be removed without hurting these vessels. Moreover, these vessels often come from the abdominal aorta and portal vein, and once bleeding occurs during surgery, it is often difficult to control it, posing a risk to life. With doctors’ in-depth understanding of pancreatic anatomy and the rapid development of modern medical imaging technology, some small pancreatic tumors can be detected at an early stage, and when these tumors do not invade the large blood vessels outside the pancreas, minimally invasive laparoscopic surgery or robotic surgery can be used to remove these tumors. The advantages of minimally invasive surgery are the same as those of other organs: smaller incisions, less damage, faster recovery and less pain. At present, minimally invasive surgery system adopts high-definition laparoscopic system or (and) robotic system, which can magnify the surgery area 5~10 times, so it is like doing surgery under a microscope, and the blood vessels as fine as hair can be handled reliably, and the fine degree of surgery can be seen, and this kind of microscopic surgery is bound to reduce the bleeding during surgery. At the same time, minimally invasive surgery has less interference with the patient’s whole body and less impact on the immune function of the body, which is more beneficial to the treatment of tumor patients. At present, this high-definition lumpectomy or robotic surgery system can do better than what is done in traditional open pancreatic surgery. Traditionally, due to its anatomical location, the blood supply to the tail of the pancreatic body is supplied by the small blood vessels emanating from the splenic artery, and the splenic artery passes through the parenchyma of the tail of the pancreatic body, so when the tail of the pancreatic body is removed due to benign or malignant tumors in the tail of the pancreatic body, the splenic artery has to be cut off as a last resort, and thus the spleen has to be removed. The spleen has to be removed. Under the minimally invasive high-definition lumpectomy system and robotic surgery system, the magnified field of view makes the small blood vessels from the splenic artery and vein supplying the pancreas clearly visible, so that we can carefully ligate each small blood vessel, so that the tail of the body of the pancreas can be removed while preserving the blood vessels of the spleen, and we call this surgery as splenoprotective tail of the pancreas. The benefits of minimally invasive surgery are not only less invasive and quicker recovery, but also avoid injuring the innocent spleen, which is more obvious. At present, minimally invasive treatment of pancreatic tumors is mainly applied to the following aspects: 1) benign tumors of the pancreas such as mucinous cystadenoma, plasmacytoma and microcystic adenoma of the pancreas; 2) neuroendocrine tumors of the pancreas such as pancreatic islet cell tumor and pancreatic hyperglycemic tumor; 3) junctional tumors of the pancreas such as intraductal papillary mucinous neoplasm of the pancreas (IPMN) and solid pseudopapillary tumor of the pancreas; 4) pancreatic cancer and so on. 4) pancreatic cancer.