Laparoscopic Whipple: An early experience

Abstract

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Laparoscopy has been applied to many intra-abdominal operations and resulted in improved patient-centered outcomes. However, its role in pancreas surgery has been limited. We describe a series of laparoscopic Whipple procedures to evaluate its feasibility and outcomes. Methods: We attempted a totally laparoscopic Whipple procedure in patients with no evidence of major vessel involvement presenting to two surgeons (MAM, BHE) over a two-year period (May 2010 May 2012). We collected data on operative time, estimated blood loss, pancreatic leak, bile leak, delayed gastric emptying, and length of stay. Results: We performed 34 laparoscopic Whipple procedures. Of these, 14 patients had a benign cyst, 17 patients had a malignant tumor, and 3 patients had a neuroendocrine tumor. The mean operative time was 6 hours, 51 min (411 minutes, range1⁄4270-600 minutes). The median estimated blood loss was 300cc (30-4000cc). A subsequent procedure was required in 2 patients (1 for a bleeding pseudoaneurysm and 1 for a bleeding gastric ulcer). Asymptomatic pancreatic leak rate occurred in 4 patients (11.8%) and asymptomatic bile leak occurred in 3 patients (8.8%). All were managed with external drainage alone. Delayed gastric emptying occurred in 3 patients (8.8%) and was self-limited. The median hospital length of stay was 8 days (range1⁄45-25 days). Conversion to open took place in 7 patients. Of these, 2 were due to extent of malignancy, 2 were due to visualization difficulty, 2 were due to bleeding, and 1 was due to a metabolic acidosis due to CO2 insufflation and COPD. The 30-day mortality was zero. Conclusions: In an early personal series performing a totally laparoscopic Whipple, we observed a high feasibility with a reasonable operative time and good patient-centered outcomes. With the optimal pancreas and laparoscopic surgery skills, laparoscopic Whipple can be performed safely.