Standardization of laparoscopic pancreato-duodenectomy at our center. Resection steponen

Abstract

Purpose: Laparoscopic pancreatoduodenectomy (PD) has recently increased worldwide. However, this procedure is technically challenging and it still needs to be standardized. We herein describe a standardized, step-by-step approach of the laparoscopic PD at our center highlighting some technical tips and tricks. Methods: This procedure was performed on a 69-year-old man with a 3 cm sized adenocarcinoma mass in the head of the pancreas. Results: After creation of a pneumoperitoneum via a 12 mm infra-umbilical port, 6 additional trocars are inserted. As showed in the video, surgery is started with division of the greater omentum. The dissection moves from medial to lateral up to a wide Kocher maneuver. Thereafter, the liver hilum is dissected with lymphadenectomy and section of gastroduodenal artery. The jejunum is transected and moved to lateral behind superior mesenteric vessels. After gastric section, a window is opened between the pancreas and superior mesenteric vein. The pancreas is transected and mesopancreas is dissected through Ligasure and radiofrequency devise (Coolingbis). Conclusions: Laparoscopic PD procedure can be a safe and feasible technique in experienced centers with advanced minimally invasive skills; it is recommended to standardize the technique for teaching purposes, replicability and to ensure patient safety.