La mentoplastica come completamento estetico nella chirurgia delle deformità delle ossa mascellari

Laparoscopy is not universally accepted as the best approach for pancreatic tumor disease. It is considered an élite surgical approach especially because of the technical difficulties involved; and the highly trained surgeons that are required to perform these operations. In addition, long operation times and lack of reduction in length of hospital stay press for the use of the laparotomic approach instead of a laparoscopic one. Four major areas of interest have been focused on: pancreato-duodenectomy, pancreas resection and enucleation, the increasingly important areas of diagnostic laparoscopy for staging of pancreatic cancer and laparoscopic palliation of unresectable pancreatic cancer. A review of the literature about laparoscopic management of pancreatic tumors disease has been examined: 14 laparoscopic pancreato-duodenectomies, 93 pancreatic resections, 41 enucleations, 4 left pancreatectomies and 2 hand assisted enucleations have been described since 1994. The laparoscopic distal pancreas resection and enucleation appear to be the best treatment option for lesions located in the body and tail of the gland; conversely laparoscopy may not be indicated for lesions located in the head of the gland. The laparoscopic approach today, does not present advantages in terms of postoperative outcome and operation times than the laparotomic approach. The hand assisted approach may be helpful in difficult cases to facilitate the operation; it permits an easier and safer dissection still conserving a minimally invasive approach. Moreover, laparoscopy is also becoming the best approach for tumor staging and palliation, and many surgeons use the laparoscopy to obtain the most information with the minimal damage in a situation already compromised by a weakening disease.