Present status and future perspectives of minimally invasive pancreatic resection in Japan

Abstract

Pancreatic resections are inevitably invasive due to anatomical, physiological and pathological features of the pancreas. To reduce the level of invasiveness, surgeons have attempted to reduce the loss of pancreatic parenchyma and preserve adjacent structures such as the duodenum and spleen. In the West, laparoscopic pancreatic resections have been performed since the 1990's and robot-assisted laparoscopic pancreatic resections have been attempted since 2000. However, in Japan, laparoscopic distal pancreatectomy was approved for reimbursement by national insurance in 2012 and robot-assisted laparoscopic pancreatic resections were approved in 2020. While our predecessors pioneered the development of minimally invasive pancreatic resections, we have been outdone by the rest of the world partly due to the late approval of laparoscopic pancreatic resections by the national insurance system. Nevertheless, we can disseminate minimally invasive pancreatic resection safely and widely throughout the country by enhancing the surgical education system. It is urgently needed to provide front-line surgeons with systematic education for robot-assisted surgery.