Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons?

Effective treatment of pancreatic pathology relies on both preoperative and intraoperative decision making. Traditionally, the use of preoperative imaging and endoscopic modalities, in combination with intraoperative findings and pathologic evaluation, has guided the surgeons to perform the correct operative procedure. We hypothesize that the intraoperative use of pancreatoscopy (fiberoptic endoscopy of the pancreatic duct) is a valuable adjunct in selected cases to facilitate the performance of the appropriate definitive surgical treatment. We queried our IRB-approved, prospectively maintained the pancreatic surgery database identifying the uses of intraoperative pancreatoscopy in all pancreatic resections at our institution from 2005-2012. Operative notes, pathology reports, and perioperative outcomes were evaluated. During the study period, 1,016 pancreatic resections were performed at our institution. Twenty-three cases during this period included the use of intraoperative pancreatoscopy. Eighteen (78 %) of these operations were performed for presumed main duct intraductal papillary mucinous neoplasm. In five cases (22 %), the surgical resection was extended secondary to the intraoperative pancreatoscopy findings. Appropriate surgical treatment of the pancreatic lesions can be challenging in the face of preoperative imaging limitations. The selective use of intraoperative fiberoptic endoscopy to evaluate the pancreatic duct appears to help to enable the surgeon to better perform the appropriate resection and optimal treatment.