Laparoscopic Duodenopancreatectomy

INTRODUCTION
Since the first report of laparoscopic pancreatic resections in the early 1990’s, laparoscopic resection of pancreatic tail tumors has become increasingly more common in the surgical treatment of both benign and malignant tumors. The minimally invasive approach to duodenopancreatectomies, however, is still only being performed in highly specialized centers. This is principally because of concerns for safely dissecting tumors off of the superior mesenteric /portal vein (SMV/PV) and the perceived difficulty in controlling major hemorrhage via the laparoscopic approach. This video will demonstrate the relevant technical maneuvers in the performance of a laparoscopic duodenopancreatectomy with the added safety of a posterior approach.
METHOD
The pertinent issues regarding absolute and relative contraindications, trochar placement, and steps necessary to perform duodenopancreatectomy via a posterior approach using minimally invasive techniques are discussed. The principal steps of this procedure include: an extended kocher maneuver with identification of the superior mesenteric artery, the retro-and supra-pancreatic dissection of the PV, a safer dissection of the ucinate process, transection of the duodeno-jejunal junction, gastric outlet, pancreas and common bile duct and laparoscopic reconstruction.
RESULTS
We have performed 35 laparoscopic duodenopancreatectomies via a posterior approach. Average operative time, estimated blood loss and lymph nodes retrieved is 360 minutes, 300 cc and 16, respectively. Our short-term and long-term outcomes are similar to open controls. No peri-operative mortalities have been observed using this technique.
CONCLUSION
Minimally invasive techniques for laparoscopic duodenopancreatectomies are feasible and safe. The posterior approach has the added benefit of making the dissection of the uncinate process off of the SMV and PV safer. Mastery of the anatomy is paramount before attempting this approach with minimally invasive techniques. It should currently only be performed by surgeons with expertise in laparoscopy and pancreatic surgery.

Session: Podium Presentation

Program Number: V003