Total laparoscopic pancreaticoduodenectomy: initial experience and short-term outcomes

Abstract

Background: Pancreaticoduodenectomy (PD) is one of the most formidable surgeries. Even such complicated procedures have been occupied by the minimally invasive approach in far advanced laparoscopic era. We would like to introduce our early experience of totally laparoscopic PD. Materials and methods: The patients were prepared in supine position and five trocars were used. Following resection, all of the reconstructions were accomplished by the laparoscopic approach intracorporeally. The specimen was retrieved through a small extension of skin incision of the umbilical camera port. Result: From March 2014 to August 2015, nine patients underwent laparoscopic PD. Pathology of resected lesions included 3 ampulla of Vater cancer, 2 bile duct cancer, 2 pancreatic cancer, 1 duodenal cancer, and 1 mucinous cystic tumor. Number of nodes harvested was 11.6 ± 2.8. The mean total operative time was 486 ± 84 min, and the mean estimated blood loss was 622 ± 281 ml. One patient was converted to minilaparotomy because of difficult dissection of the uncinate process, which patient had grade B pancreatic leakage. There was no clinically significant complications except previous one patient. The mean length of stay after surgery was 12.8 ± 4.6 days. Conclusion: Despite of worrisome potential risk and complications, laparoscopic PD could be performed safely with competent short-term outcomes. However, it is still a technically demanding and hardship operation during the initial learning curve. Further studies to evaluate long-term favorable outcomes and to develop proper training program for a steep learning curve are required.