The role of minimally invasive surgery for pancreatic pathology.

The last decade has seen an increase in the application of minimally invasive surgical procedures to the management of pancreatic disease. The role of the minimally invasive surgical procedure in the staging of pancreatic malignancies appears to be one of selective use in patients at high risk of occult metastatic disease based on high-resolution CT imaging and clinical presentation. These patients can be spared the morbidity of a nontherapeutic laparotomy. Laparoscopic pancreatic surgery is an advanced laparoscopic procedure with a significant learning curve. It should be considered only by surgeons with extensive experience in open pancreatic surgery who possess advanced laparoscopic skills. Early reports suggest that laparoscopic pancreatic surgery can be accomplished with acceptable morbidity and mortality rates for the resection of small benign and low-grade malignant lesions in the body and tail of the pancreas, as well as for the internal drainage of pancreatic pseudocysts. Its role in the management of lesions in the head, neck, and uncinate process of the pancreas has yet to be determined.