Management of pancreatic uncinate process via artery first approach in laparoscopic pancreaticoduodenectomy

Abstract

Objective To investigate the application value of management of pancreatic uncinate process via artery first approach in laparoscopic pancreaticoduodenectomy (LPD). Methods Clinical data of 10 patients who underwent LPD with artery first approach management of pancreatic uncinate process in Huadong Hospital affiliated to Fudan University between February 2015 and January 2016 were retrospectively analyzed. There were 6 males and 4 females with a mean age of (58±10) years old. Space-occupying lesions at the head of pancreas or ampulla in the patients were detected by preoperative CT and MRI. The tumor diameter was shorter than 4 cm. Neither evident vascular invasion nor distant metastasis was observed. The informed consents of all patients were obtained and the local ethical committee approval was received. The superior mesenteric artery (SMA) was first processed during the dissection of uncinate process. The SMA was skeletonized approximately 3 cm along the right edge of SMA root by harmonic scalpel. The mesentery of uncinate process was dissected behind the SMA. And then the superior mesenteric vein was pushed to the left side and the uncinate process was completely dissected from the bottom to the top. The conditions and complications during the perioperative period were observed. Results All the 10 patients underwent LPD successfully without convertion to open surgery. The operation time was (401±72) min. The dissection time of uncinate process mesentery was (34±9) min. The intraoperative hemorrhage volume was (255±183) ml. The postoperative pathological examination indicated that the incisal margin of all specimens were negative. The quantity of dissected lymph node was 14±8. Postoperative complications were observed in 4 cases, including 2 cases of grade B pancreatic fistula and 1 of delayed gastic emptying which were all cured after conservative therapy, and 1 of abdominal hemorrhage which was cured by open surgery. No death was observed during the perioperative period. Conclusions Management of pancreatic uncinate process via artery first approach is safe and feasible for LPD. It can completely resect the uncinate process and guarantee the radical resection of the tumors. Key words: Pancreaticoduodenectomy; Laparoscopes; Pancreatic uncinate process; Artery first approach