A Novel Approach for Total Laparoscopic Pancreaticoduodenectomy

Yiping Mou, MD, FACS, XiaoWu Xu, MD, Weiwei Jin, MS, Jiafei Yan, MS, Yuchen Zhou, MS, Ke Chen, MS. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.

Objective: A novel approach for total laparoscopic pancreaticoduodenectomy(TLPD) based on “Five Trocars” is developed.

Methods: The “Five trocars” fit for the Eastern body habitus (slim) are as follow: a 10mm laparoscope trocar in the midline below the umbilical scar; a 12mm trocar along the right midclavicular line, and a 5cm trocar along the right anterior axillary line for the primary surgeon; another two 5cm trocars placed along the left midclavicular line and anterior axillary line for the assistant. Thus, the visual field is “below-up” around the axis of the mesenteric-portal vein. Under the vision, the flow of resection is designed from caudad to cephalad, from anterior to posterior, from left to right. After the retropancreatic window is created to make sure it resectable, the resections are performed with transaction in order of the jejunum, stomach, pancreatic neck, gallbladder, pancreatic uncinate, common bile duct. Each procedural step helps to set up the next, thus facilitating the flow and increasing efficiency of the operation. The reconstructions with pancreaticojejunostomy (duct to mucosa), hepaticojejunostomy, gastrojejunostomy are performed.

Results: 11 TLDP with this novel approach were done between March 2013 and September 2013. The mean operating time was less than the one with traditional steps through laparoscopic approach, while there were no obviously differences about the outcomes of these procedures, but the cost was decreased by reducing the number of trocars. What’s more, the primary surgeon and assistant felt smoother with this novel approach.

Conclusion: This novel approach based on “Five trocars” is suitable for the Eastern body habitus. It not only simplifies the technique, but also is more economic.

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