1. LAPAROSCOPIC PANCREATIC SURGERY George Ferzli MD, FACS

4. I- Diagnostic

5. “ In cases of ordinary exploratory operation for carcinoma, before having recourse to the usual large incision, the cystoscope is introduced through a very small and relatively unimportant incision, possibly made with cocaine, may reveal general metastases or a secondary nodule in the liver, thus rendering further procedures unnecessary and saving the patient a rather prolonged convalescence”. 1911 Bernheim: First laparoscopy for pancreatic cancer in the U.S.A. Bernheim B. Organoscopy: Cystoscopy of the abdominal cavity. Ann Surg 53:764-767,1911

19. Results Minnard, E. Conlon, K et al, Ann Surg, 1998, 228(2) ___ ___ 13 (14%) 8 (9%) EQUIVOCAL 50 (56%) 49 (54%) 41 (46%) 17 (19%) UNRESECTABLE ACTUAL LAP SONO LAP CT

23. II- Therapeutic Laparoscopy

25. 2- MISCELLANEOUS PANCREATIC NEOPLASMS

26. Videolaparoscopic Resection of Insulinomas World Journal of Surgery Vol. 26, 2002 Laparoscopic Pancreatic Resection: Single Institution Experience of 19 Patients PETERSON, et al J Am Coll Surg 193(2),2001 Ultrasound Guided Laparoscopic Resection Of Pancreatic Islet Cell Tumors SPITZ, et al Surg Lap Endo Vol 10, 2000 DESCRIPTION STUDY

28. 3- Management of pancreatic pseudocyst and necrotizing pancreatitis

31. Urgent ERC/ES in Benign Acute Biliary Pancreatitis Neoptolemos Fan ERC Controls ERC Controls n (%) n (%) n (%) n (%) N patients 28 29 34 35 Complications - local 3 (11) 4 (14) 7 (21) 1 (3) - general 1 (4) 0 3 (9) 1 (3) Deaths 0 0 0 0

33. Surgery vs Endoscopic Sphincterotomy in Severe Cholangitis Endoscopy Surgery p Leese (non randomized) Mortality (%) 4.7 21.4 Lai (randomized) N patients 41 41 N (%) with Complications 14 (34) 27 (66) < 0.05 Deaths 4 (10) 13 (32) < 0.03

41. LAPAROSCOPIC INTERNAL DRAINAGE OF PSEUDOCYSTS Cystojejunostomy L. paracolic handsewn Palanivelu Cystojejunostomy Infracolic Cushieri Cystogastrostomy Stapled Intraluminal Litwin & Ross Cystogastrostomy Transgastric Handsewn Petelin

45. 4- Pancreatic trauma

48. III-Palliative Laparoscopy for Unresectable Pancreatic Cancer

50. Results p<0.06 p<0.05 p<0.05 Rothlin,M et al;Surg Endosc (1999) 13:1065-1069 9 days 21 days HOSPITAL STAY 0% 29% MORTALITY 7% 43% MORBIDITY LAP (n=14) OPEN (n=14)