Commentary on “Single-Port Laparoscopic Distal Pancreatectomy: Initial Experience”

In this report, Han et al. ¹ describe a small series of patients (n=12) undergoing single-port laparoscopic distal pancreatectomy and compare this series with a larger group of patients undergoing conventional laparoscopic distal pancreatectomy. Ten of the 12 patients had benign or low-grade neoplastic findings, with only 2 patients found to have adenocarcinoma. Eleven of the patients were female, and all had a body mass index of 30 kg/m² or less. Splenic preservation was successful in 4. The authors state that there was no particular selection towards the single-port group, although one would suspect that there exist conditions that would make single-port surgery very difficult, including obesity, previous surgery, or pancreatitis. Regarding the comparison between the two methods, the single-port method was associated with a much longer operative time, lower rate of splenic preservation, less blood loss, longer hospitalization, higher conversion rate, and more complications. They conclude that single-port laparoscopic distal pancreatectomy can be performed safely and effectively in highly selected patients, although clearly not with superior or even comparable results to those of conventional laparoscopic distal pancreatectomy.

These procedures were performed by a single surgeon and clearly comprise the learning curve for a technically complex and difficult procedure. In fact, conventional laparoscopic distal pancreatectomy can be a challenging undertaking itself, especially during a surgeon's learning curve. The minimally invasive method for distal pancreatectomy has repeatedly been shown to be a better operation for the patient over conventional open surgery, and the authors should be commended for attempting to continue to improve upon these results. However, based on this report, one would question whether the authors have enough experience with conventional laparoscopic distal pancreatectomy, with only 28 of these operations over the course of 7 years. Compared with other high-volume centers, this would not reach the threshold for a high-volume center, and potentially the authors have not maximized their results of conventional laparoscopic distal pancreatectomy before embarking on an even more difficult procedure.

Although there was apparent initial enthusiasm for single-port surgery, ² it has rarely been shown as an improvement over standard laparoscopy, especially for complex operations such as pancreatectomy. As it currently stands, minimally invasive distal pancreatectomy (conventional three or four port) is a well-established technique that is an improvement over open distal pancreatectomy, and single-port surgery is feasible but not proven to be beneficial over conventional laparoscopic surgery. However, as experience grows and instrument technology advances, surgeons such as the authors of this article will continue to improve upon our modern-day techniques.