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Horacio J ASBUN

Mayo Clinic Florida
Jacksonville, FL, United States
MD, FACS
1257 likes
17579 views
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Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.
HJ Asbun
Lecture
1 year ago
4150 views
160 likes
0 comments
33:33
Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.
HJ Asbun
Lecture
2 years ago
1825 views
57 likes
0 comments
13:55
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.