Minimally invasive total pancreatectomy for treatment of pancreatic neoplasms: a narrative review

Objective: The review aims to summarize and describe surgical techniques and outcomes of a minimally invasive total pancreatectomy (MITP). Background: The minimally invasive approach has gained popularity in the last decades, even in complex abdominal surgery such as pancreatic resections. Currently, many meta-analyses focused on the benefit and advantages of the minimally invasive approach compared to open surgery, especially during distal pancreatectomy. Methods: Literature research in PubMed was performed on 1 st July 2021, using minimally invasive, laparoscopic, or robotic total pancreatectomy (TP) keywords. Case reports, case series on chronic pancreatitis, and no English language manuscripts were excluded. Considering the different MI approaches, laparoscopic or robotic, the literature research identified 416 and 221 manuscripts, respectively. After Authors’ revision, 8 papers for each technique were included. The MITP is safe, feasible, and reproducible. The conversion rate was slightly higher in the laparoscopic approach (26% vs. 7%) than the robotic. Major postoperative complication, mortality, and length of hospital stay were higher in laparoscopic series compared to the robotic ones. However, the MI technique seems to offer better intraoperative and postoperative outcomes, reducing intraoperative blood loss, major postoperative complications, and length of hospital stay compared to an open approach. Conclusions: Considering the widespread of the MI approach and the increased indication for TP, further studies, including randomized controlled trials, should be performed to assess the safety and feasibility of the MITP.