Laparoscopic pancreaticoduodenectomy: a novel approach with experience of 60 cases

Weiwei Jin, MD, Yiping Mou, MD, FACS, Xiaowu Xu, MD, Renchao Zhang, MD, Miaozun Zhang, MD, Jiafei Yan, MD. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University

Background There is an increasing interest in laparoscopic pancreaticoduodenectomy (LPD), but it is still performed in “expert” hands at selected centers. One issue to promote LPD widespread is how to simply the procedure in a scientific manner to shorten the operative time, which may need an attempt to perfect the surgical steps adjusted to the view of laparoscopy.

Methods A novel approach with the advantages of visual field ‘below-up’ around the axis of the mesenteric-portal vein was performed between September 2012 and September 2014 in our center. The flow of resection is designed from caudad to cephalad, from anterior to posterior, from left to right, so the resections are done with the jejunum, stomach, pancreatic neck, Kocher maneuver, the uncinate process, common bile duct in order.

Results Laparoscopic pancreaticoduodenectomy with this novel approach was performed on 60 consecutive patients. The mean age was 58.8 years and BMI was 23.67 kg/mm. The mean operative time was 370.4 minutes with 171.27 minutes for resection, 50.39 minutes for pancreaticojejunostomy, 39.19 minutes for hepaticojejunostomy, 23.43minutes for gastrojejunostomy. The mean blood loss was 195.09 ml. The mean tumor size was 4.07cm and the mean number of havested lymph nodes was 19.48. Pathologic diagnosis were pancreatic adenocarcinoma (n=17), cholangiocarcinoma (n=6),periampullary adnocarcinoma (n=18), gastric cancer(n=1), pancreatic neuroendocrine neoplasm (n=3), pancreatic intraductal papillary mucinous neoplasm (n=3), pancreatic mucinous cystadenoma (n=6), pancreatic solid pseudopaillary neoplasm (n=1) duodenal interstitialoma (n=3), chronic pancreatitis with a suspicious mass lesion (n=2). Perioperative morbidity occurred in 17 patients and included pancreatic fistula (n=8), bile fistula (n=1), bleeding (n=5), wound complication (n=3). There was no perioperative mortality. The median length of hospital stay was 14 days.

Conclusions Laparoscopic pancreaticoduodenectomy with this novel approach with the advantages of visual field “below-up” around the axis of the mesenteric-portal vein is safe and feasible without repeated steps which may shorten the operative time.