Laparoscopic Distal Pancreatectomy

Laparoscopic distal pancreatectomy (LDP) has become increasingly popular during the last three decades as a result of its reduction in morbidity compared to an open approach. While LDP can achieve excellent outcomes, there is a learning curve associated with it. This learning curve has been scientifically investigated. In addition to the improvement in morbidity and recovery, the oncologic safety of LDP for pancreatic adenocarcinoma (PDAC) has been demonstrated. In this context, LDP can lead to a reduced interval between surgery and adjuvant chemotherapy administration with resulting optimal oncologic outcomes. When planning LDP, which can be performed using (a) lateral-to-medial or (b) medial-to-lateral dissection, it is crucial to consider clinical and anatomical factors, relationship of the distal pancreas to critical vasculature, and adjacent organ involvement. With a deep understanding of the relationship of PDAC to adjacent organs and anatomic compartments, the radical anterograde modular pancreatosplenectomy (RAMPS) procedure was developed. RAMPS is a modification of the standard LDP for PDAC that aims to minimize the risk of a positive retroperitoneal margin and to achieve an appropriate N1 lymph node dissection. Further, the advancement in LDP technique and deep understanding of the relationship of PDAC to the vasculature has led to the development of an LDP with en bloc celiac axis resection.